Healthcare Provider Details

I. General information

NPI: 1265485981
Provider Name (Legal Business Name): SOUTH BROWARD REHABILITATON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 W 38TH PL STE 3 & 4
HIALEAH FL
33012-7012
US

IV. Provider business mailing address

1570 W 38TH PL STE 3 & 4
HIALEAH FL
33012-7012
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-0096
  • Fax: 305-698-0098
Mailing address:
  • Phone: 305-698-0096
  • Fax: 305-698-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number541102-0
License Number StateFL

VIII. Authorized Official

Name: JESUS GARCIA
Title or Position: OWNER
Credential:
Phone: 305-698-0096