MEDICARE: MVR MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	CH3175	FL

General Provider Information

NPI Number	:	1104132133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVR MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	10550 NW 77TH CT STE 224
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2071
Country	:	US
Telephone Number	:	305-456-3271
Fax Number	:

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT STE 224
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2071
Country	:	US
Telephone Number	:	305-456-3271
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. YANAYS CRUZ
Credential	:
Telephone Number	:	305-456-3271

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	08/27/2010

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