Provider Demographics
NPI:1538566948
Name:PRIME REHAB MEDICAL CENTER CORP
Entity type:Organization
Organization Name:PRIME REHAB MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-370-1659
Mailing Address - Street 1:1140 W 50TH ST
Mailing Address - Street 2:STE 311
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3440
Mailing Address - Country:US
Mailing Address - Phone:786-370-1659
Mailing Address - Fax:786-370-1659
Practice Address - Street 1:1140 W 50TH ST
Practice Address - Street 2:STE 311
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3440
Practice Address - Country:US
Practice Address - Phone:786-370-1659
Practice Address - Fax:786-370-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106369261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service