Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA50948 | FL |
NPI | 1013422484 |
---|---|
Provider Name | Mr. Everildo Vigistain-Ruiz |
First Address | Hialeah, FL 33010-4553 |
Second Address | Hialeah, FL 33010-4553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA50948 | MASSAGE THERAPIST (01) | FL |