# MIAMI MEDICAL & WELLNESS CENTER LLC

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

## Provider details

- **NPI number:** 1720456676
- **Authorized official:** MR. RODOLFO DUMENIGO JR. M.D (PRESIDENT)
- **Authorized official phone:** (305) 534-0076

## Contact information

- **Practice address:** 7500 SW 8TH ST, SUITE 103, MIAMI, FL 33144-4400
- **Practice address phone:** (305) 534-0076
- **Practice address fax:** (305) 735-6471
- **Mailing address:** 1200 ALTON RD, MIAMI BEACH, FL 33139-3810
- **Mailing address phone:** (305) 534-0076
- **Mailing address fax:** (305) 907-5442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | ME58111 | FL | Yes |

## Other

- **Enumeration date:** 09/09/2015
- **Last updated:** 09/10/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11761Q | MEDICARE PTAN DUMENIGO | FL |
| 01 | — | E6931S | MEDICARE PTAN ALONSO | FL |
| 01 | — | GK944Y | MEDICARE PTAN DE LEON | FL |
| 01 | — | ID353A | MEDICARE PTAN | FL |