MEDICARE: SLEEP SPA REHAB CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1114214467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP SPA REHAB CENTER, INC.

Provider Business Mailing Address
First Line	:	145 MADEIRA AVE
Second Line	:	SUITE 202
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4520
Country	:	US
Telephone Number	:	305-567-2797
Fax Number	:	305-567-9001

Provider Business Practice Location Address
First Line	:	145 MADEIRA AVE
Second Line	:	SUITE 202
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4520
Country	:	US
Telephone Number	:	305-567-2797
Fax Number	:	305-567-9001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS GONZALEZ
Credential	:
Telephone Number	:	305-567-2797

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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