Provider Demographics
NPI:1366476954
Name:REBORN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:REBORN MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-643-6601
Mailing Address - Street 1:801 NW 37 AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33124
Mailing Address - Country:US
Mailing Address - Phone:305-643-6601
Mailing Address - Fax:
Practice Address - Street 1:801 NW 37 AVE
Practice Address - Street 2:STE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33124
Practice Address - Country:US
Practice Address - Phone:305-643-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty