Provider Demographics
NPI:1528365665
Name:ST JUDE MED AND REHAB CARE INC
Entity Type:Organization
Organization Name:ST JUDE MED AND REHAB CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YENISLEIDYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-368-3309
Mailing Address - Street 1:6850 CORAL WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1758
Mailing Address - Country:US
Mailing Address - Phone:786-368-3309
Mailing Address - Fax:
Practice Address - Street 1:6850 CORAL WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1758
Practice Address - Country:US
Practice Address - Phone:786-368-3309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44992261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center