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General NPI Number Information
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NPI Number | 1992474423
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Entity Type | Individual
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Provider Name | LISSETT GONZALEZ QUINTANA MA 93851
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 8504 NW 103RD ST
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City | HIALEAH
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State | FL
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Zip | 33016-4870
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Country | US
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Telephone | 786-420-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 W 25TH PL APT 3
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City | HIALEAH
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State | FL
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Zip | 33010-1831
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Country | US
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Telephone | 786-379-3650
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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 | MA93851
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License Number State | FL
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