Provider Demographics
NPI:1700692670
Name:ZAMZAM WELLNESS LLC
Entity type:Organization
Organization Name:ZAMZAM WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-409-8807
Mailing Address - Street 1:1400 S ORLANDO AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:407-409-8807
Mailing Address - Fax:407-557-4885
Practice Address - Street 1:1400 S ORLANDO AVE STE 210
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:407-409-8807
Practice Address - Fax:407-557-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care