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General NPI Number Information
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NPI Number | 1629016258
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Entity Type | Organization
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Legal Business Name | SAN DIEGO MEDICAL AND REHAB CENTER INC.
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6600 TAFT ST SUITE 303
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4040
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Country | US
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Telephone | 786-587-6712
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 W FLAGLER ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1446
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Country | US
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Telephone | 786-587-6712
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN HEREDIA
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Credential |
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Telephone | 786-587-6712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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