Provider Demographics
NPI:1326542648
Name:BUERGO ALVAREZ, JESUS D (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:D
Last Name:BUERGO ALVAREZ
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5501
Mailing Address - Country:US
Mailing Address - Phone:305-398-7505
Mailing Address - Fax:305-642-5385
Practice Address - Street 1:3713 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5501
Practice Address - Country:US
Practice Address - Phone:305-398-7505
Practice Address - Fax:305-642-5385
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist