Provider Demographics
NPI:1225472731
Name:REDONDO, EMILENKO (MT)
Entity Type:Individual
Prefix:
First Name:EMILENKO
Middle Name:
Last Name:REDONDO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 SW 8TH ST
Mailing Address - Street 2:STE H204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4263
Mailing Address - Country:US
Mailing Address - Phone:305-261-9285
Mailing Address - Fax:305-261-9715
Practice Address - Street 1:8150 SW 8TH ST
Practice Address - Street 2:STE H204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4263
Practice Address - Country:US
Practice Address - Phone:305-261-9285
Practice Address - Fax:305-261-9715
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63233225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist