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General NPI Number Information
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NPI Number | 1093052193
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Entity Type | Organization
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Legal Business Name | SAN JUDE REHAB AND MEDICAL CENTER, CORP.
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 8302 NW 103RD ST SUITE 202
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-4697
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Country | US
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Telephone | 305-456-6803
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Fax |
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Provider Business Mailing Address
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Address Line | 8302 NW 103RD ST SUITE 202
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-4697
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Country | US
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Telephone | 305-456-6803
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DINORAH GONZALEZ
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Credential |
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Telephone | 305-456-6803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC9743
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License Number State | FL
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