Provider Demographics
NPI:1902142763
Name:MIAMI LAKES REHAB SERVICES INC
Entity Type:Organization
Organization Name:MIAMI LAKES REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZULUETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-439-3996
Mailing Address - Street 1:13903 NW 67TH AVE
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2900
Mailing Address - Country:US
Mailing Address - Phone:786-439-3996
Mailing Address - Fax:786-439-3997
Practice Address - Street 1:13903 NW 67TH AVE
Practice Address - Street 2:SUITE # 250
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2900
Practice Address - Country:US
Practice Address - Phone:786-439-3996
Practice Address - Fax:786-439-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8269261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8269OtherMULTIPLE MEDICAL SERVICES