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General NPI Number Information
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NPI Number | 1861750259
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Entity Type | Individual
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Provider Name | MR. ROBERTO GRIMON
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Gender | Male
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 410 W 29TH ST SUITE B
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City | HIALEAH
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State | FL
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Zip | 33012-5728
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Country | US
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Telephone | 786-413-8351
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Fax | 786-732-0637
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Provider Business Mailing Address
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Address Line | 410 W 29TH ST SUITE B
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City | HIALEAH
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State | FL
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Zip | 33012-5728
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Country | US
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Telephone | 786-413-8351
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Fax | 786-732-0637
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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 | MA68283
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License Number State | FL
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