MEDICARE: MR. LUIS M. OBREGON L.M.T. N.C.B.T.M.B.

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	MA59106	FL

General Provider Information

NPI Number	:	1396049920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS M. OBREGON L.M.T. N.C.B.T.M.B.

Provider Business Mailing Address
First Line	:	9349 SW 39TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4148
Country	:	US
Telephone Number	:	305-401-4029
Fax Number	:	305-207-8254

Provider Business Practice Location Address
First Line	:	9349 SW 39TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4148
Country	:	US
Telephone Number	:	305-401-4029
Fax Number	:	305-207-8254

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

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	12/21/2010

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