Provider Demographics
NPI:1033837281
Name:SOCORRO, VENESSA (LMT)
Entity Type:Individual
Prefix:MS
First Name:VENESSA
Middle Name:
Last Name:SOCORRO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:VENESSA
Other - Middle Name:
Other - Last Name:SOCORRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:975 ARTHUR GODFREY RD STE 211
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3341
Mailing Address - Country:US
Mailing Address - Phone:786-602-6118
Mailing Address - Fax:
Practice Address - Street 1:975 ARTHUR GODFREY RD STE 211206
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3329
Practice Address - Country:US
Practice Address - Phone:786-602-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist