Healthcare Provider Details

I. General information

NPI: 1659386191
Provider Name (Legal Business Name): INFINITY REHAB CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LESLIE DR APT 807
HALLANDALE BEACH FL
33009-7317
US

IV. Provider business mailing address

200 LESLIE DR APT 807
HALLANDALE BEACH FL
33009-7317
US

V. Phone/Fax

Practice location:
  • Phone: 954-304-0447
  • Fax:
Mailing address:
  • Phone: 954-304-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO SOUTULLO
Title or Position: PRESIDENT
Credential:
Phone: 786-306-0778