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General NPI Number Information
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NPI Number | 1336997931
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Entity Type | Individual
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Provider Name | ANASTACIA MONICA KAUIMALIE ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 1600 W EAU GALLIE BLVD STE 203
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City | MELBOURNE
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State | FL
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Zip | 32935-4149
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Country | US
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Telephone | 321-987-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 VERANDA CT UNIT 3
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City | MELBOURNE
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State | FL
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Zip | 32901-8743
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Country | US
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Telephone | 941-467-8043
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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 | MA87055
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License Number State | FL
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