=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487897385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAJGO BETTER CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2009
-----------------------------------------------------
Last Update Date | 04/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 NW 79TH AVE SUITE # 215
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-716-8711
-----------------------------------------------------
Fax | 305-716-8712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3900 NW 79TH AVE SUITE # 215
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-716-8711
-----------------------------------------------------
Fax | 305-716-8712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. RAMIRO GOMEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-716-8711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | MA43120
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------