MEDICARE: MR. JESUS D BUERGO ALVAREZ MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA72393	FL

General Provider Information

NPI Number	:	1326542648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESUS D BUERGO ALVAREZ MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	3713 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5501
Country	:	US
Telephone Number	:	305-398-7505
Fax Number	:	305-642-5385

Provider Business Practice Location Address
First Line	:	3713 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5501
Country	:	US
Telephone Number	:	305-398-7505
Fax Number	:	305-642-5385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	03/21/2018

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