Healthcare Provider Details

I. General information

NPI: 1255149233
Provider Name (Legal Business Name): OG REHABILITATION CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 GRAND CANAL DR STE 404
MIAMI FL
33144-2571
US

IV. Provider business mailing address

85 GRAND CANAL DR STE 404
MIAMI FL
33144-2571
US

V. Phone/Fax

Practice location:
  • Phone: 305-565-1551
  • Fax:
Mailing address:
  • Phone: 305-726-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LIUSMALKYS AGUILAR VALENTI
Title or Position: PRESIDENT
Credential:
Phone: 305-726-9961