Provider Demographics
NPI:1396797171
Name:DORAL OUTPATIENT REHAB
Entity type:Organization
Organization Name:DORAL OUTPATIENT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-7138
Mailing Address - Street 1:13212 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1176
Mailing Address - Country:US
Mailing Address - Phone:305-551-7138
Mailing Address - Fax:305-551-7220
Practice Address - Street 1:13212 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1176
Practice Address - Country:US
Practice Address - Phone:305-551-7138
Practice Address - Fax:305-551-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI17114Medicare UPIN
FLG00653Medicare UPIN