Healthcare Provider Details

I. General information

NPI: 1508790643
Provider Name (Legal Business Name): PRIME HEALTH REHAB CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 NW 25TH ST STE 205
DORAL FL
33122-1622
US

IV. Provider business mailing address

12821 SW 43RD DR APT 131
MIAMI FL
33175-4119
US

V. Phone/Fax

Practice location:
  • Phone: 786-320-2675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN CARMONA
Title or Position: PRESIDENT
Credential:
Phone: 786-320-2675