Provider Demographics
NPI:1619574092
Name:TAMIAMI WELLNESS CLUB
Entity Type:Organization
Organization Name:TAMIAMI WELLNESS CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIRAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-982-8771
Mailing Address - Street 1:14255 SW 42ND ST 13B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6408
Mailing Address - Country:US
Mailing Address - Phone:305-982-8771
Mailing Address - Fax:305-402-6110
Practice Address - Street 1:14255 SW 42ND ST # B-13
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6408
Practice Address - Country:US
Practice Address - Phone:305-982-8771
Practice Address - Fax:305-402-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108308300Medicaid