Provider Demographics
NPI:1063816791
Name:GENESIS WELLNESS & REHAB CENTER INC
Entity Type:Organization
Organization Name:GENESIS WELLNESS & REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-406-4291
Mailing Address - Street 1:330 SW 27TH AVE STE 703
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2968
Mailing Address - Country:US
Mailing Address - Phone:786-406-4291
Mailing Address - Fax:
Practice Address - Street 1:330 SW 27TH AVE STE 703
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2968
Practice Address - Country:US
Practice Address - Phone:786-406-4291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62641261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local