Healthcare Provider Details

I. General information

NPI: 1942513361
Provider Name (Legal Business Name): NEURO REHABILITATION ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 SW 75TH AVE
MIAMI FL
33155-2800
US

IV. Provider business mailing address

PO BOX 142064
CORAL GABLES FL
33114-2064
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-9554
  • Fax: 786-235-1074
Mailing address:
  • Phone: 305-445-9554
  • Fax: 786-235-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY4145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberPY6075
License Number StateFL

VIII. Authorized Official

Name: DR. JORGE A HERRERA
Title or Position: PARTNER
Credential: PHD
Phone: 305-445-9554