Provider Demographics
NPI:1396024204
Name:SOUTH FLORIDA SPEECH AND HEARING REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SPEECH AND HEARING REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:786-301-0554
Mailing Address - Street 1:4920 SW 64TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6142
Mailing Address - Country:US
Mailing Address - Phone:786-301-0554
Mailing Address - Fax:
Practice Address - Street 1:4920 SW 64TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6142
Practice Address - Country:US
Practice Address - Phone:786-301-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty