Provider Demographics
NPI:1922342906
Name:MD AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:MD AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-7700
Mailing Address - Street 1:2541 N DALE MABRY HWY UNIT 413
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2408
Mailing Address - Country:US
Mailing Address - Phone:813-876-7700
Mailing Address - Fax:813-876-8700
Practice Address - Street 1:4730 N HABANA AVE STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7148
Practice Address - Country:US
Practice Address - Phone:813-876-7700
Practice Address - Fax:813-876-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003245000Medicaid
FL280564200Medicaid
FL003245000Medicaid
FL280564200Medicaid