Healthcare Provider Details

I. General information

NPI: 1215366299
Provider Name (Legal Business Name): ALL STATE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 SW 132ND CT SUITE 212
MIAMI FL
33186-6464
US

IV. Provider business mailing address

12360 SW 132ND CT SUITE 212
MIAMI FL
33186-6464
US

V. Phone/Fax

Practice location:
  • Phone: 330-525-2214
  • Fax: 305-252-2068
Mailing address:
  • Phone: 330-525-2214
  • Fax: 305-252-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL INFANTR
Title or Position: PRESIDENT
Credential:
Phone: 305-252-2145