Healthcare Provider Details

I. General information

NPI: 1841732922
Provider Name (Legal Business Name): FLOBAMER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 SW 149TH AVE APT B216
MIAMI FL
33193-1466
US

IV. Provider business mailing address

8002 SW 149TH AVE APT B216
MIAMI FL
33193-1466
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-6178
  • Fax:
Mailing address:
  • Phone: 305-979-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA45867
License Number StateFL

VIII. Authorized Official

Name: JOEL A QUINTANA
Title or Position: MEMBER
Credential: LMT
Phone: 305-979-6178