Individual
MAYDELIN MATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3311 SW 92ND AVE, MIAMI, FL 33165-4125
(786) 366-5638
Mailing address
3311 SW 92ND AVE, MIAMI, FL 33165-4125
(786) 366-5638
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA63613
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA63613
FLORIDA STATE LICENSE
FL
Enumeration date
06/15/2011
Last updated
06/15/2011
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