Provider Demographics
NPI:1518335348
Name:HARBOR BAY MEDICAL CENTER, CORP.
Entity Type:Organization
Organization Name:HARBOR BAY MEDICAL CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-274-0144
Mailing Address - Street 1:3900 NW 79TH AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6549
Mailing Address - Country:US
Mailing Address - Phone:786-238-7771
Mailing Address - Fax:855-299-0714
Practice Address - Street 1:3900 NW 79TH AVE STE 509
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6549
Practice Address - Country:US
Practice Address - Phone:786-238-7771
Practice Address - Fax:855-299-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10419261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy