Provider Demographics
NPI:1083228274
Name:JARA AGUIRRE, MONICA TATIANA (LMT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:TATIANA
Last Name:JARA AGUIRRE
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 1:10715 SW 224TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-6562
Mailing Address - Country:US
Mailing Address - Phone:786-398-0181
Mailing Address - Fax:
Practice Address - Street 1:10715 SW 224TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-6562
Practice Address - Country:US
Practice Address - Phone:786-398-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA87976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist