Portofino Wellness Spa LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PORTOFINO WELLNESS SPA LLC

Practice address

107 Westward Dr Unit 660515
Miami Springs, FL 33266-0529

Phone

(305) 303-0649

Fax

(866) 885-9540

NPI assigned

May 12, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas A Knigge Jr.

Title

Manager / President

Phone

(305) 303-0649

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494547200000",
    "number": "1861929549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WESTWARD DR UNIT 660515",
            "city": "MIAMI SPRINGS",
            "state": "FL",
            "postal_code": "332660529",
            "telephone_number": "305-303-0649",
            "fax_number": "866-885-9540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WESTWARD DR UNIT 660515",
            "city": "MIAMI SPRINGS",
            "state": "FL",
            "postal_code": "332660529",
            "telephone_number": "305-303-0649",
            "fax_number": "866-885-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTOFINO WELLNESS SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-12",
        "last_updated": "2017-05-12",
        "status": "A",
        "authorized_official_last_name": "KNIGGE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER / PRESIDENT",
        "authorized_official_telephone_number": "305-303-0649",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.