=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558058446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE REHABILITATION CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2023
-----------------------------------------------------
Last Update Date | 04/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 SW 27TH AVE SUITE 504
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-488-4301
-----------------------------------------------------
Fax | 786-534-2917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 SW 27TH AVE SUITE 504
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-488-4301
-----------------------------------------------------
Fax | 786-534-2917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MGR
-----------------------------------------------------
Name | PROF. CARLOS A DIAZ VALLADARES
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 786-488-4301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------