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General NPI Number Information
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NPI Number | 1003180449
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Entity Type | Organization
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Legal Business Name | MACYAS SYSTEM INC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 8009 NW 36TH ST STE 236
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City | DORAL
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State | FL
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Zip | 33166-6638
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Country | US
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Telephone | 305-717-2440
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Fax | 305-717-2422
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Provider Business Mailing Address
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Address Line | 8009 NW 36TH ST STE 236
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City | DORAL
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State | FL
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Zip | 33166-6638
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Country | US
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Telephone | 305-717-2440
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Fax | 305-717-2422
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONARDO HERNANDEZ
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Credential | MASSAGE THERAPIST
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Telephone | 305-717-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MA66162
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License Number State | FL
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