Individual
JORGE LUIS DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
15306 SW 39TH TER, MIAMI, FL 33185-4702
(786) 955-5546
Mailing address
15306 SW 39TH TER, MIAMI, FL 33185-4702
(786) 955-5546
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 58704
FL
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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