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General NPI Number Information
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NPI Number | 1417511213
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Entity Type | Individual
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Provider Name | ANYELIT SEQUERA ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 5000 UNIVERSITY DR
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City | CORAL GABLES
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State | FL
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Zip | 33146-2008
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Country | US
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Telephone | 786-337-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 5670 NW 116TH AVE APT 221
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City | DORAL
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State | FL
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Zip | 33178-4190
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Country | US
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Telephone | 786-337-0810
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4608
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License Number State | FL
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