Krystal Rehabilitation Services, Corp

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

HCC9762 Issued in FL

Legal business name

KRYSTAL REHABILITATION SERVICES, CORP

Practice address

6187 NW 167TH St Ste H13
Miami Lakes, FL 33015-4308

Phone

(305) 599-5258

Fax

(305) 599-5259

NPI assigned

Sep 3, 2013

Last updated

Oct 29, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jorge Luis Gonzalez

Title

President

Phone

(305) 599-5258

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1982039442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6187 NW 167TH ST STE H13",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330154308",
            "telephone_number": "305-599-5258",
            "fax_number": "305-599-5259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6187 NW 167TH ST STE H13",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330154308",
            "telephone_number": "305-599-5258",
            "fax_number": "305-599-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRYSTAL REHABILITATION SERVICES, CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-599-5258",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "HCC9762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.