Healthcare Provider Details

I. General information

NPI: 1487891511
Provider Name (Legal Business Name): ABEL ABRAHAM FLEITAS MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7483 SW 24TH ST SUITE 103
MIAMI FL
33155-1454
US

IV. Provider business mailing address

5896 SW 17TH ST
MIAMI FL
33155-2121
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6884
  • Fax: 305-262-6885
Mailing address:
  • Phone: 786-539-6429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberMA 44211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: