Healthcare Provider Details

I. General information

NPI: 1275820367
Provider Name (Legal Business Name): MR. PEDRO J OQUENDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 NW 77TH CT SUIT 201
DORAL FL
33166-4110
US

IV. Provider business mailing address

7210 W 29TH AVE
HIALEAH FL
33018-5348
US

V. Phone/Fax

Practice location:
  • Phone: 786-523-1068
  • Fax:
Mailing address:
  • Phone: 786-523-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA59742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: