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General NPI Number Information
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NPI Number | 1003181389
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Entity Type | Individual
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Provider Name | YOSMEL O CARRASCO
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Gender | Male
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 3910 SANTA BARBARA BLVD 103
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City | CAPE CORAL
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State | FL
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Zip | 33914
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Country | US
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Telephone | 239-810-7586
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 150669
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City | CAPE CORAL
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State | FL
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Zip | 33915-0669
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Country | US
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Telephone | 239-205-4362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA65897
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License Number State | FL
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