# ST JUDE HEALTH WELLNESS CENTER CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336661925
- **Authorized official:** MARILYN RODRIGUEZ (OWNER)
- **Authorized official phone:** (786) 362-6248

## Contact information

- **Practice address:** 10200 NW 25TH ST STE 114, DORAL, FL 33172-5919
- **Practice address phone:** (786) 362-6248
- **Practice address fax:** (786) 362-6331
- **Mailing address:** 10200 NW 25TH ST STE 114, DORAL, FL 33172-5919
- **Mailing address phone:** (786) 362-6248
- **Mailing address fax:** (786) 362-6331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | HCC11081 | FL | Yes |

## Other

- **Enumeration date:** 07/14/2017
- **Last updated:** 10/05/2020