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General NPI Number Information
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NPI Number | 1629398631
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Entity Type | Organization
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Legal Business Name | FLORIDA WELLNESS & REHABILITATION CENTER OF FIU/KENDALL LLC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 11890 SW 8TH ST STE 400
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City | MIAMI
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State | FL
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Zip | 33184-1742
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Country | US
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Telephone | 305-685-9771
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Fax | 305-685-9776
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Provider Business Mailing Address
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Address Line | 11890 SW 8TH ST STE 400
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City | MIAMI
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State | FL
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Zip | 33184-1742
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Country | US
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Telephone | 305-685-9771
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Fax | 305-685-9776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK A CERECEDA
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Credential |
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Telephone | 305-685-9771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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