=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144538141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D.R. REHABILITATION CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2010
-----------------------------------------------------
Last Update Date | 09/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5757 SW 8TH ST STE 204
-----------------------------------------------------
City | WEST MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-5060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-338-1472
-----------------------------------------------------
Fax | 786-294-0909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5757 SW 8TH ST STE 204
-----------------------------------------------------
City | WEST MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-5060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-338-1472
-----------------------------------------------------
Fax | 786-294-0909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAFAEL P SENESPLEDA I
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 786-338-1472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | MA 47501
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------