Provider Demographics
NPI:1003492604
Name:PEOLES, NILDA CRISTINA
Entity Type:Individual
Prefix:
First Name:NILDA
Middle Name:CRISTINA
Last Name:PEOLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 EUCLID AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-8677
Mailing Address - Country:US
Mailing Address - Phone:786-346-8461
Mailing Address - Fax:
Practice Address - Street 1:626 EUCLID AVE APT 7
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-8677
Practice Address - Country:US
Practice Address - Phone:786-346-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA76986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist