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General NPI Number Information
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NPI Number | 1851665491
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Entity Type | Individual
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Provider Name | JORGE LUIS SIMON MA63525
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Gender | Male
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 13414 SW 22ND TER
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City | MIAMI
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State | FL
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Zip | 33175-1138
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Country | US
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Telephone | 786-366-6695
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Fax | 786-401-7646
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Provider Business Mailing Address
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Address Line | 13414 SW 22ND TER
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City | MIAMI
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State | FL
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Zip | 33175-1138
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Country | US
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Telephone | 786-366-6695
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Fax | 786-401-7646
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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 | MA63525
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License Number State | FL
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