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General NPI Number Information
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NPI Number | 1649590092
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Entity Type | Organization
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Legal Business Name | FOUNTAINBLEAU REHAB CORP
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 175 FONTAINEBLEAU BLVD SUITE 2G-10
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City | MIAMI
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State | FL
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Zip | 33172-7018
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Country | US
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Telephone | 305-552-5554
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Fax | 305-552-5564
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Provider Business Mailing Address
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Address Line | PO BOX 228653
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City | MIAMI
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State | FL
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Zip | 33222-8653
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Country | US
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Telephone | 305-552-5554
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Fax | 305-552-5564
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Authorized Official
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Title or Position | OWNER
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Name | ANDRES COFINO
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Credential | MA
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Telephone | 305-552-5554
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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 | FL
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