Provider Demographics
NPI:1609388453
Name:PROMEDICAL CENTER HIALEAH CORP
Entity Type:Organization
Organization Name:PROMEDICAL CENTER HIALEAH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-953-4471
Mailing Address - Street 1:900 W 49TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3407
Mailing Address - Country:US
Mailing Address - Phone:786-953-4471
Mailing Address - Fax:786-703-5185
Practice Address - Street 1:900 W 49TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3407
Practice Address - Country:US
Practice Address - Phone:786-953-4471
Practice Address - Fax:786-703-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78770208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty