Provider Demographics
NPI:1366850984
Name:ENDOCRINOLOGY WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:ENDOCRINOLOGY WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
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 1:1643 E CLASSICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1204
Mailing Address - Country:US
Mailing Address - Phone:765-404-4136
Mailing Address - Fax:954-111-1111
Practice Address - Street 1:7545 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6166
Practice Address - Country:US
Practice Address - Phone:765-404-4136
Practice Address - Fax:954-111-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100283207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK633ZMedicare Oscar/Certification