Provider Demographics
NPI:1376563668
Name:MIAMI DADE HEALTH AND REHABILITATION SERVICES
Entity Type:Organization
Organization Name:MIAMI DADE HEALTH AND REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-0590
Mailing Address - Street 1:3233 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5427
Mailing Address - Country:US
Mailing Address - Phone:305-642-0590
Mailing Address - Fax:305-643-6326
Practice Address - Street 1:30334 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3215
Practice Address - Country:US
Practice Address - Phone:305-245-0200
Practice Address - Fax:305-245-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1133Medicare ID - Type Unspecified