Provider Demographics
NPI:1043667405
Name:C.O.R. INJURY CENTERS, INC.
Entity type:Organization
Organization Name:C.O.R. INJURY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAMALIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-235-5595
Mailing Address - Street 1:13501 SW 128TH ST
Mailing Address - Street 2:STE 116
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5882
Mailing Address - Country:US
Mailing Address - Phone:305-235-5595
Mailing Address - Fax:305-235-5594
Practice Address - Street 1:13501 SW 128TH ST
Practice Address - Street 2:STE 116
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5882
Practice Address - Country:US
Practice Address - Phone:305-235-5595
Practice Address - Fax:305-235-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7411232261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service