1366638652 NPI number — MS. PAULA ARLENE NIEVAS LMT

Table of content: MS. PAULA ARLENE NIEVAS LMT (NPI 1366638652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366638652 NPI number — MS. PAULA ARLENE NIEVAS LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEVAS
Provider First Name:
PAULA
Provider Middle Name:
ARLENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366638652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11652 NE 11 PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-525-8612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4407 SHERIDAN ST
Provider Second Line Business Practice Location Address:
HOLISTIC MASSAGE & WELLNESS CLINICS
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-893-7233
Provider Business Practice Location Address Fax Number:
954-893-5635
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  1578694915 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA48642 . This is a "STATE OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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