MEDICARE: STELLATO-PEREZ HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	133NN1002X	Nutrition Education Nutritionist	FL
2	225700000X	Massage Therapist	FL
3	171100000X	Acupuncturist	FL

General Provider Information

NPI Number	:	1336474246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STELLATO-PEREZ HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	17150 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3102
Country	:	US
Telephone Number	:	305-890-8681
Fax Number	:

Provider Business Practice Location Address
First Line	:	17150 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3102
Country	:	US
Telephone Number	:	305-890-8681
Fax Number	:

Authorized Official
Title or Position	:	MANAGER MEMBER
Name	:	MRS. MARIA E STELLATO
Credential	:	L.AC. MS
Telephone Number	:	305-890-8681

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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