1619992435 NPI number — GRAND MEDICAL REHAB CENTER INC

Table of content: DR. OBINNA C. UZOWULU M.D. (NPI 1003007295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619992435 NPI number — GRAND MEDICAL REHAB CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND MEDICAL REHAB CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619992435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4182 W 12TH AVE
Provider Second Line Business Mailing Address:
GRAND MEDICAL REHAB CENTER INC.
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-824-5024
Provider Business Mailing Address Fax Number:
305-824-5026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4182 W 12TH AVE
Provider Second Line Business Practice Location Address:
GRAND MEDICAL REHAB CENTER INC.
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-824-5025
Provider Business Practice Location Address Fax Number:
305-824-5026
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VALDES
Authorized Official First Name:
JACKELINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
305-824-5025

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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