Healthcare Provider Details

I. General information

NPI: 1629016258
Provider Name (Legal Business Name): SAN DIEGO MEDICAL AND REHAB CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 TAFT ST SUITE 303
HOLLYWOOD FL
33024-4040
US

IV. Provider business mailing address

4800 W FLAGLER ST
CORAL GABLES FL
33134-1446
US

V. Phone/Fax

Practice location:
  • Phone: 786-587-6712
  • Fax:
Mailing address:
  • Phone: 786-587-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: JUAN HEREDIA
Title or Position: PRESIDENT
Credential:
Phone: 786-587-6712