Organization
ST JUDE HEALTH WELLNESS CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN RODRIGUEZ (OWNER)
(786) 362-6248
Entity
Organization
Contact information
Practice address
10200 NW 25TH ST STE 114, DORAL, FL 33172-5919
(786) 362-6248
(786) 362-6331
Mailing address
10200 NW 25TH ST STE 114, DORAL, FL 33172-5919
(786) 362-6248
(786) 362-6331
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
HCC11081
FL
Other
Enumeration date
07/14/2017
Last updated
10/05/2020
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