MEDICARE: ES REHAB PROFESSIONAL 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	207Q00000X	Family Medicine Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	2085R0202X	Diagnostic Radiology Physician
4	261QH0100X	Health Service Clinic/Center	AHCA HCC 8958	FL
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386948222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ES REHAB PROFESSIONAL CENTER, INC

Provider Business Mailing Address
First Line	:	5600 SW 135TH AVE STE 216
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5101
Country	:	US
Telephone Number	:	786-536-6196
Fax Number	:	786-558-9425

Provider Business Practice Location Address
First Line	:	5600 SW 135TH AVE STE 216
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5101
Country	:	US
Telephone Number	:	786-536-6196
Fax Number	:	786-558-9425

Authorized Official
Title or Position	:	OWNER
Name	:	MIGUEL PADRON
Credential	:
Telephone Number	:	786-536-6196

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	07/17/2024

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