Healthcare Provider Details

I. General information

NPI: 1285419648
Provider Name (Legal Business Name): MONA SLUDER PRESTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 GIRALDA AVE STE M
CORAL GABLES FL
33134-5208
US

IV. Provider business mailing address

195 GIRALDA AVE STE M
CORAL GABLES FL
33134-5208
US

V. Phone/Fax

Practice location:
  • Phone: 305-567-1973
  • Fax:
Mailing address:
  • Phone: 305-567-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA56785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: