Provider Demographics
NPI:1578838637
Name:SAN LAZARO REHAB CENTER CORP
Entity Type:Organization
Organization Name:SAN LAZARO REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANIER
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:ARCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-327-8517
Mailing Address - Street 1:2500 NW 79TH AVE STE 288
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 288
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1090
Practice Address - Country:US
Practice Address - Phone:305-290-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58457261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation