| Genesis Wound Care Center Llc | |
|
4995 Nw 72nd Ave Ste 406 Miami FL 33166-5643 | |
| (305) 603-8410 | |
| (786) 431-5976 |
| Full Name | Genesis Wound Care Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4995 Nw 72nd Ave Ste 406, Miami, Florida |
| Authorized Official Name and Position | Mayelin Alonso (OWNER) |
| Authorized Official Contact | 3056038410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Wound Care Center Llc 4995 Nw 72nd Ave Ste 406 Miami FL 33166-5643 Ph: (305) 603-8410 | Genesis Wound Care Center Llc 4995 Nw 72nd Ave Ste 406 Miami FL 33166-5643 Ph: (305) 603-8410 |
| NPI Number | 1306516919 |
|---|---|
| Provider Enumeration Date | 09/15/2021 |
| Last Update Date | 09/16/2021 |
| Medicare PECOS PAC ID | 7517358575 |
|---|---|
| Medicare Enrollment ID | O20211229002174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306516919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Diamina Molina Vidal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861970428 PECOS PAC ID: 0143568626 Enrollment ID: I20190207001164 |
| Provider Name | Miladys Vienes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083190755 PECOS PAC ID: 3577802396 Enrollment ID: I20190222000082 |
| Provider Name | Mayelin Alonso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710447172 PECOS PAC ID: 3072945930 Enrollment ID: I20191114000389 |
| Provider Name | Osmin Padron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790310779 PECOS PAC ID: 4486074440 Enrollment ID: I20201014000636 |
| Provider Name | Marianela Chinea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154945731 PECOS PAC ID: 0042620312 Enrollment ID: I20201028001323 |
| Provider Name | Elizabeth Guadarrama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548803836 PECOS PAC ID: 0749692788 Enrollment ID: I20201215002322 |
| Provider Name | Yaima Rosquete Santana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982287207 PECOS PAC ID: 6901208065 Enrollment ID: I20210712002746 |
| Provider Name | Carlos J Hernandez Morffiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740947761 PECOS PAC ID: 7315337318 Enrollment ID: I20211207000164 |
| Provider Name | Zurester Fleitas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013475938 PECOS PAC ID: 4385012947 Enrollment ID: I20221201002912 |
| Provider Name | Ruben Benitez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629666136 PECOS PAC ID: 8325454945 Enrollment ID: I20221229000487 |
| Provider Name | Aylema Mursuli De La Torre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902592702 PECOS PAC ID: 9436515921 Enrollment ID: I20230525003322 |
| Provider Name | Yener De La Caridad Valdes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518414077 PECOS PAC ID: 8628435245 Enrollment ID: I20230613000528 |
| Provider Name | Yamiri Leon Infante |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134802929 PECOS PAC ID: 2365896347 Enrollment ID: I20230925002017 |
| Provider Name | Nelson Sori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285245282 PECOS PAC ID: 0840645578 Enrollment ID: I20231016001399 |
| Provider Name | Luis Avila |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306448303 PECOS PAC ID: 4486565272 Enrollment ID: I20240318002549 |
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