Healthcare Provider Details

I. General information

NPI: 1356599161
Provider Name (Legal Business Name): SOUTH BAY REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SW 8TH ST 302
MIAMI FL
33135-3433
US

IV. Provider business mailing address

PO BOX 140151
CORAL GABLES FL
33114-0151
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-9241
  • Fax:
Mailing address:
  • Phone: 305-300-9241
  • Fax:

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: BANCA VAZQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-300-9241