MEDICARE: GUSTAVO DORIGO LMT

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	MA57122	FL

General Provider Information

NPI Number	:	1740894393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO DORIGO LMT

Provider Business Mailing Address
First Line	:	7745 HARDING AVE APT 4
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2134
Country	:	US
Telephone Number	:	305-992-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	7745 HARDING AVE APT 4
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2134
Country	:	US
Telephone Number	:	305-992-6144
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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Directions to “ GUSTAVO DORIGO LMT” Practice Location

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