Provider Demographics
NPI:1154329019
Name:PARK PLAZA REHABILITATION ASSOC., P.A.
Entity Type:Organization
Organization Name:PARK PLAZA REHABILITATION ASSOC., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:713-527-0120
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:#700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-527-0120
Mailing Address - Fax:713-527-8131
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:#700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-527-0120
Practice Address - Fax:713-527-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI26524Medicare UPIN
TXC20854Medicare UPIN
TX8D3379Medicare ID - Type UnspecifiedMICHALE ABDELSAYED, D.O.
TX80X870Medicare ID - Type UnspecifiedREMBERTO RANGEL, M. D.
TX00R31HMedicare ID - Type UnspecifiedPARK PLAZA REHAB. ASSOC.,