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General NPI Number Information
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NPI Number | 1073147955
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Entity Type | Individual
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Provider Name | JAIME M MINGUEZ LMT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 144 METRO PARK
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City | ROCHESTER
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State | NY
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Zip | 14623-2653
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Country | US
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Telephone | 585-671-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 268 WILDBRIAR RD
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City | ROCHESTER
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State | NY
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Zip | 14623-3952
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Country | US
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Telephone | 585-319-6770
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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 | 031689
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License Number State | NY
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