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General NPI Number Information
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NPI Number | 1982241972
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Entity Type | Individual
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Provider Name | KRISTEN MONIQUE DE LA RUA LMT
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Gender | Female
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 7600 SW 57TH AVE STE 304
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5427
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Country | US
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Telephone | 305-663-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 570 NE 64TH ST APT 6
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City | MIAMI
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State | FL
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Zip | 33138-6149
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Country | US
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Telephone | 305-975-1201
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA41588
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License Number State | FL
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