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General NPI Number Information
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NPI Number | 1396063483
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Entity Type | Individual
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Provider Name | PEDRO VEGA ENAMORADO MA
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Gender | Male
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 9180 SW 203RD TER
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City | CUTLER BAY
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State | FL
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Zip | 33189-1855
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Country | US
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Telephone | 786-389-6003
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Fax | 305-253-6193
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Provider Business Mailing Address
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Address Line | 9180 SW 203RD TER
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City | CUTLER BAY
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State | FL
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Zip | 33189-1855
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Country | US
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Telephone | 786-389-6003
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Fax | 305-253-6193
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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 | MA56236
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License Number State | FL
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