Healthcare Provider Details

I. General information

NPI: 1134050420
Provider Name (Legal Business Name): JOSE ANGEL PAVON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SW 147TH AVE APT 3C
MIAMI FL
33193-1011
US

IV. Provider business mailing address

6901 SW 147TH AVE APT 3C APT 3C
MIAMI FL
33193-1011
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-8740
  • Fax:
Mailing address:
  • Phone: 305-742-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA105271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: