Provider Demographics
NPI:1679888218
Name:R.A WELLNES MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:R.A WELLNES MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-392-1493
Mailing Address - Street 1:7221 SW 24TH ST
Mailing Address - Street 2:SUITE 206-209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1436
Mailing Address - Country:US
Mailing Address - Phone:305-392-1493
Mailing Address - Fax:305-392-1495
Practice Address - Street 1:7221 SW 24TH ST
Practice Address - Street 2:SUITE 206-209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1436
Practice Address - Country:US
Practice Address - Phone:305-392-1493
Practice Address - Fax:305-392-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center