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Organization
MIAMI MEDICAL & WELLNESS CENTER LLC
Active
Organization
MIAMI MEDICAL & WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODOLFO DUMENIGO JR. M.D (PRESIDENT)
(305) 534-0076
Entity
Organization
Contact information
Practice address
551 E 49TH ST, SUITE 1-8, HIALEAH, FL 33013-1904
(305) 532-3923
(305) 532-5868
Mailing address
1200 ALTON RD, MIAMI BEACH, FL 33139-3810
(305) 534-0076
(305) 532-5868
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME87037
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11761Q
MEDICARE PTAN DUM
FL
01
—
E6931S
MEDICARE PTAN ALO
FL
01
—
GK944Y
PTAN DE L
FL
01
—
ID353A
MEDICARE PTAN
FL
Enumeration date
02/21/2014
Last updated
07/13/2015
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