Healthcare Provider Details

I. General information

NPI: 1396049920
Provider Name (Legal Business Name): LUIS M. OBREGON L.M.T. N.C.B.T.M.B.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9349 SW 39TH ST
MIAMI FL
33165-4148
US

IV. Provider business mailing address

9349 SW 39TH ST
MIAMI FL
33165-4148
US

V. Phone/Fax

Practice location:
  • Phone: 305-401-4029
  • Fax: 305-207-8254
Mailing address:
  • Phone: 305-401-4029
  • Fax: 305-207-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA59106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: