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General NPI Number Information
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NPI Number | 1083601454
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Entity Type | Organization
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Legal Business Name | EAST GABLES REHAB INC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 8346 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33155-3337
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Country | US
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Telephone | 305-552-5210
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Fax | 305-552-5209
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Provider Business Mailing Address
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Address Line | 8346 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33155-3337
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Country | US
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Telephone | 305-552-5210
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Fax | 305-552-5209
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS M IZQUIERDO
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Credential |
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Telephone | 305-552-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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