Healthcare Provider Details

I. General information

NPI: 1770051047
Provider Name (Legal Business Name): ABA REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SW 87TH AVE STE 104
MIAMI FL
33165-5472
US

IV. Provider business mailing address

3850 SW 87TH AVE STE 104
MIAMI FL
33165-5472
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-1766
  • Fax: 305-456-6443
Mailing address:
  • Phone: 305-456-1766
  • Fax: 305-456-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENRY URDANIVIA
Title or Position: OWNER
Credential: MA
Phone: 305-456-1766