Organization
SOUTHERN REHABILITATION GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN BLANCO LEZCANO LMHC (OWNER)
(786) 319-0748
Entity
Organization
Contact information
Practice address
6447 MIAMI LAKES DR E STE 200E, MIAMI LAKES, FL 33014-2706
(786) 319-0748
Mailing address
6447 MIAMI LAKES DR E STE 200E, MIAMI LAKES, FL 33014-2706
(786) 319-0748
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
747907
—
FL
Enumeration date
04/17/2019
Last updated
04/17/2019
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