Provider Demographics
NPI:1669055646
Name:AFFORDABLE MEDICAL AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:AFFORDABLE MEDICAL AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-494-4415
Mailing Address - Street 1:9780 W HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2343
Mailing Address - Country:US
Mailing Address - Phone:305-494-4415
Mailing Address - Fax:
Practice Address - Street 1:9780 W HEATHER LN
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2343
Practice Address - Country:US
Practice Address - Phone:305-494-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center