Individual
CARLOS ALBERTO MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5127 NW 39TH AVE, GAINESVILLE, FL 32606-5943
(352) 327-4023
Mailing address
5127 NW 39TH AVE, GAINESVILLE, FL 32606-5943
(352) 327-4023
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA69514
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA69514
STATE LICENSURE MASSAGE THERAPIST
FL
Enumeration date
12/26/2012
Last updated
12/26/2012
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