Healthcare Provider Details

I. General information

NPI: 1942401898
Provider Name (Legal Business Name): MG REHABILITATION MEDICAL CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE SUITE #134 U
HIALEAH FL
33012-4654
US

IV. Provider business mailing address

3750 W 16TH AVE SUITE #134 U
HIALEAH FL
33012-4654
US

V. Phone/Fax

Practice location:
  • Phone: 305-231-7145
  • Fax:
Mailing address:
  • Phone: 305-231-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9004
License Number StateFL

VIII. Authorized Official

Name: MAITE GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 305-231-7145