Provider Demographics
NPI:1699208058
Name:PRESTIGE MEDICAL REHAB CENTER INC
Entity type:Organization
Organization Name:PRESTIGE MEDICAL REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-464-0207
Mailing Address - Street 1:2711 SW 137TH AVE
Mailing Address - Street 2:SUITE 97
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6359
Mailing Address - Country:US
Mailing Address - Phone:786-464-0207
Mailing Address - Fax:786-953-4546
Practice Address - Street 1:2711 SW 137TH AVE
Practice Address - Street 2:SUITE 97
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6359
Practice Address - Country:US
Practice Address - Phone:786-464-0207
Practice Address - Fax:786-953-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty