=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528255171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC TRAUMATOLOGY & REHAB CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2007
-----------------------------------------------------
Last Update Date | 09/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9950 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-551-7340
-----------------------------------------------------
Fax | 305-226-6695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9950 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-551-7340
-----------------------------------------------------
Fax | 305-226-6695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MARIA R PLIEGO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-551-7340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 4783537
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------