Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | ME126067 | FL |
Y | 213ES0000X | Sports Medicine | ME126067 | FL |
NPI | 1043550718 |
---|---|
Provider Name | Melissa Marie Guanche |
First Address | Miami, FL 33176-2127 |
Second Address | Miami, FL 33176-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2013 |
Last Update Date | 01/10/2018 |