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General NPI Number Information
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NPI Number | 1235895798
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Entity Type | Individual
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Provider Name | IRIS CAROLINA OTERO CASTRO LMT
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 10300 SUNSET DR STE 459
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City | MIAMI
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State | FL
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Zip | 33173-3000
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Country | US
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Telephone | 786-720-8296
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Fax |
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Provider Business Mailing Address
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Address Line | 12321 SW 268TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33032-7950
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Country | US
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Telephone | 305-721-4221
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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 | MA92306
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License Number State | FL
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