Healthcare Provider Details

I. General information

NPI: 1558014472
Provider Name (Legal Business Name): LUCKY MEDICAL & REHABILITATION CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W FLAGLER ST STE 100
MIAMI FL
33144-3212
US

IV. Provider business mailing address

6001 W FLAGLER ST STE 100
MIAMI FL
33144-3212
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-4685
  • Fax: 786-953-4934
Mailing address:
  • Phone: 786-953-4685
  • Fax: 786-953-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENIER MARRERO
Title or Position: PRESIDENT
Credential:
Phone: 786-222-5963