Provider Demographics
NPI:1124839618
Name:DIAMOND WELLNESS & MED CENTER LLC
Entity type:Organization
Organization Name:DIAMOND WELLNESS & MED CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PEREZ -PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-439-6017
Mailing Address - Street 1:1470 NW 107TH AVE STE M
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2735
Mailing Address - Country:US
Mailing Address - Phone:786-439-6017
Mailing Address - Fax:
Practice Address - Street 1:1470 NW 107TH AVE STE M
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2735
Practice Address - Country:US
Practice Address - Phone:786-439-6017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)