Healthcare Provider Details

I. General information

NPI: 1801620976
Provider Name (Legal Business Name): MELBA OLMEDA B.A M.A. A.A.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N OCEAN BLVD APT 14G
FORT LAUDERDALE FL
33308-7305
US

IV. Provider business mailing address

3015 N OCEAN BLVD APT 14G
FORT LAUDERDALE FL
33308-7305
US

V. Phone/Fax

Practice location:
  • Phone: 917-834-6262
  • Fax:
Mailing address:
  • Phone: 917-834-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA986624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: