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General NPI Number Information
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NPI Number | 1639464407
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Entity Type | Organization
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Legal Business Name | LUNA KATZUTRA WELLNESS INC
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 9835 SW 72ND ST SUITE 208
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City | MIAMI
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State | FL
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Zip | 33173-4670
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Country | US
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Telephone | 305-381-5429
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Fax | 305-381-5542
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Provider Business Mailing Address
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Address Line | 9835 SW 72ND ST SUITE 208
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City | MIAMI
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State | FL
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Zip | 33173-4670
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Country | US
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Telephone | 305-381-5429
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Fax | 305-381-5542
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | MR. EDGAR N ESCOBAR
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Credential | MD
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Telephone | 305-381-5429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 65056
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License Number State | FL
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