=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285842575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S AND B MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11373 W FLAGLER ST SUITE 204
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-226-3214
-----------------------------------------------------
Fax | 305-226-3264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11373 W FLAGLER ST SUITE 204
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-226-3214
-----------------------------------------------------
Fax | 305-226-3264
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SERGIO MONTOYA
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 305-226-3214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MM19546
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------