Healthcare Provider Details

I. General information

NPI: 1841567401
Provider Name (Legal Business Name): CORAL PARK REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 SW 24TH ST STE 111
MIAMI FL
33155-6541
US

IV. Provider business mailing address

7815 SW 24TH ST STE 111
MIAMI FL
33155-6541
US

V. Phone/Fax

Practice location:
  • Phone: 786-235-3759
  • Fax: 786-235-3760
Mailing address:
  • Phone: 786-235-3759
  • Fax: 786-235-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberME 0081213
License Number StateFL

VIII. Authorized Official

Name: LILIANA SANCHEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-235-3759