MEDICARE: MS. AUREA CARMELA MONDRAGON MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA 9219	FL

General Provider Information

NPI Number	:	1649235227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUREA CARMELA MONDRAGON MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	4400 SW 115TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5526
Country	:	US
Telephone Number	:	305-554-4460
Fax Number	:	305-663-4442

Provider Business Practice Location Address
First Line	:	6341 SUNSET DR
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4842
Country	:	US
Telephone Number	:	305-662-5924
Fax Number	:	305-663-4442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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