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Organization

BREVARD WELLNESS CLINC 1 LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SRINIVAS RAO DONTINENI M.D. (PRESIDENT)
(321) 751-9506
Entity
Organization

Contact information

Practice address
1264 MALABAR RD SE, PALM BAY, FL 32907-2556
(321) 751-9506
(321) 751-9505
Mailing address
1264 MALABAR RD SE, PALM BAY, FL 32907-2556
(321) 751-9506
(321) 751-9505

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME88036
FL

Other

Enumeration date
01/31/2014
Last updated
01/31/2014
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