Provider Demographics
NPI:1174793954
Name:VENETIAN REHAB CENTER INC
Entity type:Organization
Organization Name:VENETIAN REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:YANEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-879-6668
Mailing Address - Street 1:434 SW 12TH AVE
Mailing Address - Street 2:#103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2440
Mailing Address - Country:US
Mailing Address - Phone:786-879-6668
Mailing Address - Fax:
Practice Address - Street 1:434 SW 12TH AVE
Practice Address - Street 2:#103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2440
Practice Address - Country:US
Practice Address - Phone:786-879-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty