Provider Demographics
NPI:1700859048
Name:REBELLO MEDICAL ASSOCIATES MD PL
Entity Type:Organization
Organization Name:REBELLO MEDICAL ASSOCIATES MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:IGNATIUS
Authorized Official - Last Name:REBELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-637-8383
Mailing Address - Street 1:13590 S JOG RD STE C3
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-637-8383
Mailing Address - Fax:561-423-9253
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:SUITE C3
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-637-8383
Practice Address - Fax:561-423-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114058400Medicaid