Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA65897 | FL |
NPI | 1003181389 |
---|---|
Provider Name | Yosmel O Carrasco |
First Address | Cape Coral, FL 33915-0669 |
Second Address | Cape Coral, FL 33914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 20/03/2012 |