Healthcare Provider Details

I. General information

NPI: 1962955476
Provider Name (Legal Business Name): DIANA BALMASEDA MT25056
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 W 2ND CT
HIALEAH FL
33012-6716
US

IV. Provider business mailing address

6524 W 2ND CT
HIALEAH FL
33012-6716
US

V. Phone/Fax

Practice location:
  • Phone: 305-613-6193
  • Fax:
Mailing address:
  • Phone: 305-613-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT25056M
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: