Healthcare Provider Details

I. General information

NPI: 1245976265
Provider Name (Legal Business Name): OPAL REHABILITATION CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931B SW 87TH AVE
MIAMI FL
33174-3206
US

IV. Provider business mailing address

931B SW 87TH AVE
MIAMI FL
33174-3206
US

V. Phone/Fax

Practice location:
  • Phone: 754-267-8471
  • Fax:
Mailing address:
  • Phone: 754-267-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENIO ALXIDE HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-381-5244