Provider Demographics
NPI:1073761342
Name:DERISMA, JOI
Entity Type:Individual
Prefix:
First Name:JOI
Middle Name:
Last Name:DERISMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOI
Other - Middle Name:
Other - Last Name:DERISMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8912 W FLAGLER ST
Mailing Address - Street 2:#203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3950
Mailing Address - Country:US
Mailing Address - Phone:954-918-7180
Mailing Address - Fax:
Practice Address - Street 1:5961 NW 173RD DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5114
Practice Address - Country:US
Practice Address - Phone:305-556-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist