Provider Demographics
NPI:1588085542
Name:VISTA MEDICAL REHEB CENTER. INC
Entity type:Organization
Organization Name:VISTA MEDICAL REHEB CENTER. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUTIE COUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:786-487-1786
Mailing Address - Street 1:4355 W 16TH AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4355 W 16 AVE SUITE 212
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7670
Practice Address - Country:US
Practice Address - Phone:786-487-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit