Basic Information
| Provider Information | |||||||||
| NPI: | 1265791156 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORA HEALTH SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10570 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331742612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052221892 | ||||||||
| FaxNumber: | 3052221896 | ||||||||
| Practice Location | |||||||||
| Address1: | 10570 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331742612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052221892 | ||||||||
| FaxNumber: | 3052221896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2012 | ||||||||
| LastUpdateDate: | 05/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | PINEDA | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PTA, CLINIC MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3052221892 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | PTA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 20435 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.