Organization
MANANTIAL DE VIDA NUEVA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIULIS RODRIGUEZ (PRESIDENT)
(305) 233-8055
Entity
Organization
Contact information
Practice address
13255 SW 137TH AVE, STE. 100, MIAMI, FL 33186-5326
(305) 233-8055
(786) 573-4677
Mailing address
13255 SW 137TH AVE, STE. 100, MIAMI, FL 33186-5326
(305) 233-8055
(786) 573-4677
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC8847
FL
Other
Enumeration date
05/16/2011
Last updated
05/16/2011
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