Individual
KLEYVIS MESA JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5040 E 4TH AVE APT 6, HIALEAH, FL 33013-1560
(786) 318-7108
Mailing address
5040 E 4TH AVE APT 6, HIALEAH, FL 33013-1560
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA76414
MASSAGE THERAPIST LICENCE
FL
Enumeration date
10/28/2014
Last updated
10/28/2014
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