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General NPI Number Information
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NPI Number | 1962658351
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Entity Type | Individual
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Provider Name | IVAN MAURICIO GIRALDO L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 2072 S MILITARY TRL SUITE # 4
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-6419
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Country | US
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Telephone | 561-281-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 2072 S MILITARY TRL SUITE # 4
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-6419
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Country | US
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Telephone | 561-281-5522
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | MA23533
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License Number State | FL
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