=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982631495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENALBA REHABILITATION MEDICINE P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 07/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8700 N KENDALL DR SUITE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-403-2921
-----------------------------------------------------
Fax | 305-403-2928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 557335
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33255-7335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-251-3991
-----------------------------------------------------
Fax | 305-251-7982
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | CLAUDIA PENALBA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-662-5126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | ME0066217
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------