Provider Demographics
NPI:1003180449
Name:MACYAS SYSTEM INC
Entity Type:Organization
Organization Name:MACYAS SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:305-717-2440
Mailing Address - Street 1:8009 NW 36TH ST STE 236
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6638
Mailing Address - Country:US
Mailing Address - Phone:305-717-2440
Mailing Address - Fax:305-717-2422
Practice Address - Street 1:8009 NW 36TH ST STE 236
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6638
Practice Address - Country:US
Practice Address - Phone:305-717-2440
Practice Address - Fax:305-717-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66162305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service