Provider Demographics
NPI:1255664371
Name:DECAMARGO, MARIA IZABEL
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:IZABEL
Last Name:DECAMARGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6967 SW 115TH PLACE
Mailing Address - Street 2:UNIT G
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1890
Mailing Address - Country:US
Mailing Address - Phone:786-291-6059
Mailing Address - Fax:
Practice Address - Street 1:6967 SW 115TH PL
Practice Address - Street 2:UNIT G
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1805
Practice Address - Country:US
Practice Address - Phone:305-596-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 49871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 49871OtherMASSAGE THERAPY