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General NPI Number Information
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NPI Number | 1417229725
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Entity Type | Organization
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Legal Business Name | CELEBRITY REHAB INC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 50 NW 15TH ST SUITE 101
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City | HOMESTEAD
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State | FL
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Zip | 33030-4266
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Country | US
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Telephone | 786-515-9771
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Fax | 305-248-2780
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Provider Business Mailing Address
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Address Line | 50 NW 15TH ST SUITE 101
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City | HOMESTEAD
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State | FL
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Zip | 33030-4266
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Country | US
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Telephone | 786-515-9771
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Fax | 305-248-2780
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERNIE HERNANDEZ
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Credential |
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Telephone | 786-515-9771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number | ME28403
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9589
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License Number State | FL
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