=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013361203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TEBA ORUETA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2016
-----------------------------------------------------
Last Update Date | 04/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 NE 17TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-1194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-302-6359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 66 VALENCIA AVE APT 1103
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-302-6359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA67631
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------