Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA81013 | FL |
NPI | 1003408444 |
---|---|
Provider Name | Olga J Fernandez |
First Address | Miami, FL 33176-5778 |
Second Address | Miami, FL 33176-5778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2021 |
Last Update Date | 08/02/2021 |