Provider Demographics
NPI:1316551013
Name:WEST, RANDI NINA (LMT, CMLDT)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:NINA
Last Name:WEST
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:NINA
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, CMLDT
Mailing Address - Street 1:500 THREE ISLANDS BLVD APT 1004
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2841
Mailing Address - Country:US
Mailing Address - Phone:305-467-3024
Mailing Address - Fax:954-251-3578
Practice Address - Street 1:3532 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6752
Practice Address - Country:US
Practice Address - Phone:305-467-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-51104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0289955556OtherMASSAGE LIABILITY INSURANCE