Provider Demographics
NPI:1881733350
Name:MIROS THERAPY CENTER
Entity type:Organization
Organization Name:MIROS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIROSLAVA
Authorized Official - Middle Name:VAZQUEZ
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-5003
Mailing Address - Street 1:3990 W FLAGLER ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1644
Mailing Address - Country:US
Mailing Address - Phone:305-448-5003
Mailing Address - Fax:305-448-4710
Practice Address - Street 1:3990 W FLAGLER ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1644
Practice Address - Country:US
Practice Address - Phone:305-448-5003
Practice Address - Fax:305-448-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686548Medicare ID - Type Unspecified