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General NPI Number Information
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NPI Number | 1487943619
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Entity Type | Organization
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Legal Business Name | WEST KENDALL REHAB, INC.
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 4445 W 16TH AVE STE 505
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City | HIALEAH
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State | FL
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Zip | 33012-2960
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Country | US
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Telephone | 305-512-1717
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Fax | 305-512-1713
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Provider Business Mailing Address
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Address Line | 4445 W 16TH AVE STE 505
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City | HIALEAH
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State | FL
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Zip | 33012-2960
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Country | US
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Telephone | 305-512-1717
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Fax | 305-512-1713
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Authorized Official
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Title or Position | PRESIDENT
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Name | INTI FERNANDEZ
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Credential | M.D
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Telephone | 305-512-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME97323
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License Number State | FL
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