=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033515465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARIEN REHAB CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2014
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7175 SW 8TH ST SUITE 218
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-534-9882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7175 SW 8TH ST SUITE 218
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-534-9882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIDUVINO BARRIOS
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 786-534-9882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | PT15233
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------