# FENIX MEDICAL CLINIC, CORP.

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

## Provider details

- **NPI number:** 1902580699
- **Authorized official:** ELENA R FOWLER (OWNER)
- **Authorized official phone:** (305) 824-2023

## Contact information

- **Practice address:** 4701 W 4TH AVE., HIALEAH, FL 33012
- **Practice address phone:** (786) 542-9702
- **Mailing address:** 4701 W 4TH AVE., HIALEAH, FL 33012
- **Mailing address phone:** (305) 824-2023
- **Mailing address fax:** (786) 814-5703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2023
- **Last updated:** 06/13/2023