Provider Demographics
NPI:1104524354
Name:CELLMAX MEDICAL GROUP, CORP
Entity type:Organization
Organization Name:CELLMAX MEDICAL GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YESIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-487-6626
Mailing Address - Street 1:17699 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3627
Mailing Address - Country:US
Mailing Address - Phone:786-487-6626
Mailing Address - Fax:
Practice Address - Street 1:17699 NW 78TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3627
Practice Address - Country:US
Practice Address - Phone:786-487-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service