Provider Demographics
NPI:1083020895
Name:ENDOCRINOLOGY WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:ENDOCRINOLOGY WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-404-4136
Mailing Address - Street 1:13660 JOG ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3806
Mailing Address - Country:US
Mailing Address - Phone:561-600-2408
Mailing Address - Fax:561-600-2414
Practice Address - Street 1:13660 JOG ROAD SUITE 2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-6166
Practice Address - Country:US
Practice Address - Phone:561-600-2408
Practice Address - Fax:561-600-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100283261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281264900Medicaid
FLI01176Medicare UPIN