Healthcare Provider Details

I. General information

NPI: 1205301942
Provider Name (Legal Business Name): PHOENIX REHAB CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 W FLAGLER ST STE 106
MIAMI FL
33144-2063
US

IV. Provider business mailing address

8500 W FLAGLER ST STE 106
MIAMI FL
33144-2063
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-2917
  • Fax: 786-703-2945
Mailing address:
  • Phone: 786-703-2917
  • Fax: 786-703-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL LOZADA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 239-841-6797