Organization
GENESIS MEDICAL WELLNESS CENTER CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA C VITAL (PRECIDENT)
(305) 603-7800
Entity
Organization
Contact information
Practice address
8356 SW 40TH ST, STE L, MIAMI, FL 33155-3356
(305) 228-6400
(305) 228-6500
Mailing address
8356 SW 40TH ST, STE L, MIAMI, FL 33155-3356
(305) 228-6400
(305) 228-6500
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
AHCA HCC8215
FL
Other
Enumeration date
03/17/2010
Last updated
10/15/2012
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