=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871629907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROMAN CENTER FOR REHABILITATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2007
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9600 SW 8TH ST STE 23B
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-300-5499
-----------------------------------------------------
Fax | 305-228-9628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9600 SW 8TH ST STE 23B
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-300-5499
-----------------------------------------------------
Fax | 305-228-9628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT CEO
-----------------------------------------------------
Name | DR. ALFONSO HURTADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-300-5499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------