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General NPI Number Information
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NPI Number | 1508801200
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Entity Type | Organization
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Legal Business Name | ABC THERAPEUTIC CENTER, INC.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 1800 SW 1ST ST SUITE 102
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City | MIAMI
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State | FL
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Zip | 33135-1960
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Country | US
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Telephone | 305-646-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 SW 1ST ST SUITE 102
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City | MIAMI
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State | FL
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Zip | 33135-1960
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Country | US
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Telephone | 305-646-5900
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MR. JOSE JOAQUIN GRAVIER
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Credential | M.T.
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Telephone | 305-646-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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