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General NPI Number Information
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NPI Number | 1962565564
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Entity Type | Individual
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Provider Name | MILAGROS MESA L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2415 S VOLUSIA AVE SUITE A-2
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City | ORANGE CITY
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State | FL
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Zip | 32763-7623
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Country | US
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Telephone | 386-775-6879
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Fax | 386-775-0307
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Provider Business Mailing Address
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Address Line | 325 WALNUT AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-6010
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Country | US
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Telephone | 386-775-6879
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Fax | 386-775-0307
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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 | MA47185
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License Number State | FL
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