Provider Demographics
NPI:1356599161
Name:SOUTH BAY REHAB INC
Entity type:Organization
Organization Name:SOUTH BAY REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-9241
Mailing Address - Street 1:PO BOX 140151
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-0151
Mailing Address - Country:US
Mailing Address - Phone:305-300-9241
Mailing Address - Fax:
Practice Address - Street 1:1850 SW 8TH ST
Practice Address - Street 2:302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3433
Practice Address - Country:US
Practice Address - Phone:305-300-9241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation