Provider Demographics
NPI:1609834993
Name:IDEAL REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:IDEAL REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-260-0188
Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-260-0188
Mailing Address - Fax:305-260-0168
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-260-0188
Practice Address - Fax:305-260-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686692Medicare ID - Type Unspecified