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General NPI Number Information
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NPI Number | 1992077754
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Entity Type | Individual
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Provider Name | ERNESTO LUZ M.T
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Gender | Male
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 6315 NW 113TH TER
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City | HIALEAH
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State | FL
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Zip | 33012-2331
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Country | US
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Telephone | 786-715-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 5701 W 25 CT APT# 111
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City | HIALEAH
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State | FL
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Zip | 33016-4478
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Country | US
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Telephone | 786-715-2368
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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 | MA56712
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License Number State | FL
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