Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 52691 | FL |
NPI | 1003079732 |
---|---|
Provider Name | Luis A Tellez |
First Address | Coconut Grove, FL 33133-4636 |
Second Address | Miami, FL 33176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |