MEDICARE: PACIFIC CARE REHAB LLC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1356906309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC CARE REHAB LLC

Provider Business Mailing Address
First Line	:	11900 BISCAYNE BLVD STE 809
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11900 BISCAYNE BLVD STE 809
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2726
Country	:	US
Telephone Number	:	520-272-5427
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ELHAM NAREI
Credential	:
Telephone Number	:	520-272-5427

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	05/06/2019

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