Healthcare Provider Details

I. General information

NPI: 1891293916
Provider Name (Legal Business Name): ESTELA MABEL VATRI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 PIERCE ST APT 7
HOLLYWOOD FL
33020-3875
US

IV. Provider business mailing address

2640 PIERCE ST APT 7
HOLLYWOOD FL
33020-3875
US

V. Phone/Fax

Practice location:
  • Phone: 786-234-0867
  • Fax: 786-999-8234
Mailing address:
  • Phone: 786-234-0867
  • Fax: 786-999-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: