=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376856849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA PILOTO MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 07/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 W 39TH PL STE 1001
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-7036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-454-2243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6961 W 14TH CT APT 204
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-4568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-454-2243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA42219
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------