MEDICARE: YD MEDICAL REHABILITATION CENTER

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1215279096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YD MEDICAL REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	4999 W 8TH AVE STE 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-698-2296
Fax Number	:	305-698-2295

Provider Business Practice Location Address
First Line	:	4999 W 8TH AVE STE 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-698-2296
Fax Number	:	305-698-2295

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAIRON MARTIN
Credential	:
Telephone Number	:	305-698-2296

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/20/2013

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