Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 62495 | FL |
NPI | 1003107186 |
---|---|
Provider Name | Lazaro Hernandez |
First Address | Miami, FL 33174-3206 |
Second Address | Miami, FL 33174-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA 62495 | MASSAGE THERAPIST (01) | FL |