Healthcare Provider Details

I. General information

NPI: 1134658149
Provider Name (Legal Business Name): GLG REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 CORAL WAY STE 505
MIAMI FL
33155-1694
US

IV. Provider business mailing address

7171 CORAL WAY STE 100-505
MIAMI FL
33155-1449
US

V. Phone/Fax

Practice location:
  • Phone: 305-640-5560
  • Fax: 786-309-8242
Mailing address:
  • Phone: 305-640-5560
  • Fax: 305-640-5294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEIMIS RODRIGUEZ AVILA
Title or Position: OWNER
Credential:
Phone: 305-640-5560