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General NPI Number Information
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NPI Number | 1548712441
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Entity Type | Individual
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Provider Name | YARA SILVIA URQUIZA BUSTAMANTE MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 299 ALHAMBRA CIR SUITE 309
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City | CORAL GABLES
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State | FL
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Zip | 33134-5106
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Country | US
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Telephone | 786-967-0626
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Fax |
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Provider Business Mailing Address
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Address Line | 2465 SW 18TH AVE APT 3305
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City | MIAMI
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State | FL
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Zip | 33145-3879
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Country | US
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Telephone | 786-564-8257
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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 | MA79821
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License Number State | FL
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