Provider Demographics
NPI:1740550193
Name:MIAMI MEDICAL & REHAB CENTER INC.
Entity type:Organization
Organization Name:MIAMI MEDICAL & REHAB CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEAGUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-9941
Mailing Address - Street 1:3408 W 84TH ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4939
Mailing Address - Country:US
Mailing Address - Phone:305-558-9941
Mailing Address - Fax:305-558-9951
Practice Address - Street 1:3408 W 84TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4939
Practice Address - Country:US
Practice Address - Phone:305-558-9941
Practice Address - Fax:305-558-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 28295261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC9337OtherAHCA LICENSE