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General NPI Number Information
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NPI Number | 1184058406
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Entity Type | Organization
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Legal Business Name | NEW MOON MASSAGE SERVICES INC
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 1140 W 50TH ST SUITE 402
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City | HIALEAH
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State | FL
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Zip | 33012-3440
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Country | US
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Telephone | 305-888-2002
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Fax | 305-888-2003
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Provider Business Mailing Address
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Address Line | 1140 W 50TH ST SUITE 402
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City | HIALEAH
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State | FL
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Zip | 33012-3440
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Country | US
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Telephone | 305-888-2002
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Fax | 305-888-2003
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN C CORREA VILA
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Credential |
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Telephone | 305-888-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC8563
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License Number State | FL
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