St Jude Health Wellness Center Corp
Physical Medicine & Rehabilitation in Doral, FL. Organization (NPI-2).
NPI number1336661925
StatusActive
Last updated in NPPESOct 5, 2020
Details
- NPI
- 1336661925
- Entity type
- Organization (NPI-2)
- Legal business name
- St Jude Health Wellness Center Corp
- Organization subpart
- No
- Enumeration date
- Jul 14, 2017
- Certification date
- Oct 5, 2020
- Last updated
- Oct 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | HCC11081 | FL | Yes |
Practice location
10200 Nw 25th St Ste 114Doral, FL 33172-5919
Phone 786-362-6248 · Fax 786-362-6331
Mailing address
10200 Nw 25th St Ste 114Doral, FL 33172-5919
Phone 786-362-6248 · Fax 786-362-6331
Authorized official
Marilyn Rodriguez
Owner
7863626248
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