Healthcare Provider Details

I. General information

NPI: 1831432160
Provider Name (Legal Business Name): ELITE REHAB&MEDICAL CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 W 16TH AVE STE 212
HIALEAH FL
33012-7670
US

IV. Provider business mailing address

4355 W 16TH AVE STE 212
HIALEAH FL
33012-7670
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-6178
  • Fax:
Mailing address:
  • Phone: 305-979-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JOEL A QUINTANA
Title or Position: PRESIDENT
Credential: LMT
Phone: 305-979-6178