Provider Demographics
NPI:1386735272
Name:DOWNTOWN WELLNESS CENTER CORP.
Entity type:Organization
Organization Name:DOWNTOWN WELLNESS CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-372-2390
Mailing Address - Street 1:210 NE 18TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1118
Mailing Address - Country:US
Mailing Address - Phone:305-372-2390
Mailing Address - Fax:305-372-2460
Practice Address - Street 1:210 NE 18TH ST STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1118
Practice Address - Country:US
Practice Address - Phone:305-372-2390
Practice Address - Fax:305-372-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6760208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9145Medicare ID - Type UnspecifiedMEDICARE PROVIDER