Provider Demographics
NPI:1790011716
Name:PULMONARY PROVIDERS REHAB INC.
Entity Type:Organization
Organization Name:PULMONARY PROVIDERS REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-4474
Mailing Address - Street 1:1352 SW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4422
Mailing Address - Country:US
Mailing Address - Phone:305-266-4474
Mailing Address - Fax:305-266-4474
Practice Address - Street 1:1352 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4422
Practice Address - Country:US
Practice Address - Phone:305-266-4474
Practice Address - Fax:305-266-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT5541 AND TN7986293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP09000000741OtherCORPORATION DOCUMENT NUMBER