=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851693188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIANET REHAB CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2010
-----------------------------------------------------
Last Update Date | 11/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11890 SW 8TH ST SUITE 208
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-6181
-----------------------------------------------------
Fax | 305-222-6187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11890 SW 8TH ST SUITE 208
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-6181
-----------------------------------------------------
Fax | 305-222-6187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. ALDO CABREJA OLIVERA
-----------------------------------------------------
Credential | ETC
-----------------------------------------------------
Telephone | 305-222-6181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------