Healthcare Provider Details

I. General information

NPI: 1093762049
Provider Name (Legal Business Name): SANTA MARTA CENTRO DE DIAGNOSTICO Y REHABILITACION, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW 16TH ST
MIAMI FL
33145-2067
US

IV. Provider business mailing address

2200 SW 16TH ST
MIAMI FL
33145-2062
US

V. Phone/Fax

Practice location:
  • Phone: 305-858-0323
  • Fax: 305-858-1513
Mailing address:
  • Phone: 305-858-0323
  • Fax: 305-858-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberHCC6875
License Number StateFL

VIII. Authorized Official

Name: OMAYSA RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-828-0323