Provider Demographics
NPI:1326650573
Name:BWELL CLINICAL RESEARCH CORP.
Entity Type:Organization
Organization Name:BWELL CLINICAL RESEARCH CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAKSE
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:MOREJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-942-8635
Mailing Address - Street 1:10500 NW 26TH ST # A102A
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2158
Mailing Address - Country:US
Mailing Address - Phone:786-953-8043
Mailing Address - Fax:305-675-8060
Practice Address - Street 1:10500 NW 26TH ST # A102A
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2158
Practice Address - Country:US
Practice Address - Phone:786-953-8043
Practice Address - Fax:305-675-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch