Provider Demographics
NPI:1669550513
Name:PRIORITY MEDICAL REHAB
Entity type:Organization
Organization Name:PRIORITY MEDICAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:NOGAREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-480-1111
Mailing Address - Street 1:12781 SW 42ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3437
Mailing Address - Country:US
Mailing Address - Phone:305-480-1111
Mailing Address - Fax:
Practice Address - Street 1:12781 SW 42ND ST STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3437
Practice Address - Country:US
Practice Address - Phone:305-480-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6740Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER