Organization
LORENA DE JESUS REHABILITATION CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAZARO BACALLAO (PRESIDENT)
(305) 505-6242
Entity
Organization
Contact information
Practice address
275 FONTAINEBLEAU BLVD, SUITE 185, MIAMI, FL 33172-4591
(305) 505-6242
(305) 675-2668
Mailing address
275 FONTAINEBLEAU BLVD, SUITE 185, MIAMI, FL 33172-4591
(305) 505-6242
(305) 675-2668
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/02/2010
Last updated
02/02/2010
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