Provider Demographics
NPI:1043506124
Name:CHAVEZ PENA, MABEL (LMT)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:CHAVEZ PENA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 NW 12TH ST
Mailing Address - Street 2:SUITE 229
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1827
Mailing Address - Country:US
Mailing Address - Phone:305-597-7361
Mailing Address - Fax:
Practice Address - Street 1:7925 NW 12TH ST
Practice Address - Street 2:SUITE 229
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1827
Practice Address - Country:US
Practice Address - Phone:305-597-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist