Healthcare Provider Details

I. General information

NPI: 1255964052
Provider Name (Legal Business Name): CAROL C ESPANA ACOSTA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 W 84TH ST STE 309
HIALEAH GARDENS FL
33018-4944
US

IV. Provider business mailing address

3408 W 84TH ST STE 309
HIALEAH GARDENS FL
33018-4944
US

V. Phone/Fax

Practice location:
  • Phone: 954-765-6505
  • Fax: 954-861-4522
Mailing address:
  • Phone: 954-765-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA92012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: