Provider Demographics
NPI:1720456676
Name:MIAMI MEDICAL & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:MIAMI MEDICAL & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMENIGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-534-0076
Mailing Address - Street 1:1200 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3810
Mailing Address - Country:US
Mailing Address - Phone:305-534-0076
Mailing Address - Fax:305-907-5442
Practice Address - Street 1:7500 SW 8TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4400
Practice Address - Country:US
Practice Address - Phone:305-534-0076
Practice Address - Fax:305-735-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58111207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11761QOtherMEDICARE PTAN DUMENIGO
FLID353AOtherMEDICARE PTAN
FLE6931SOtherMEDICARE PTAN ALONSO
FLGK944YOtherMEDICARE PTAN DE LEON