Provider Demographics
NPI:1669247953
Name:MAGNOLIA SLEEP CENTER AND WELLNESS, LLC
Entity type:Organization
Organization Name:MAGNOLIA SLEEP CENTER AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-849-5093
Mailing Address - Street 1:6244 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3942
Mailing Address - Country:US
Mailing Address - Phone:954-342-9737
Mailing Address - Fax:
Practice Address - Street 1:6244 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3942
Practice Address - Country:US
Practice Address - Phone:954-342-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty