Provider Demographics
NPI:1710426093
Name:ADVANCED KINETICS CORP
Entity Type:Organization
Organization Name:ADVANCED KINETICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:GRAJALES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:305-333-0284
Mailing Address - Street 1:16381 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1309
Mailing Address - Country:US
Mailing Address - Phone:305-333-0284
Mailing Address - Fax:888-855-6681
Practice Address - Street 1:16381 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1309
Practice Address - Country:US
Practice Address - Phone:305-333-0284
Practice Address - Fax:888-855-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13889261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation