Healthcare Provider Details

I. General information

NPI: 1356906309
Provider Name (Legal Business Name): PACIFIC CARE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 BISCAYNE BLVD STE 809
NORTH MIAMI FL
33181-2726
US

IV. Provider business mailing address

11900 BISCAYNE BLVD STE 809
NORTH MIAMI FL
33181-2726
US

V. Phone/Fax

Practice location:
  • Phone: 520-272-5427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: ELHAM NAREI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 520-272-5427