Provider Demographics
NPI:1598915662
Name:LEGON PEREZ, MARISOL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:LEGON PEREZ
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 1:250 NE 191ST ST
Mailing Address - Street 2:APT 3004 A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3889
Mailing Address - Country:US
Mailing Address - Phone:786-306-2592
Mailing Address - Fax:
Practice Address - Street 1:250 NE 191ST ST
Practice Address - Street 2:APT 3004 A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3889
Practice Address - Country:US
Practice Address - Phone:786-306-2592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 51704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 51704OtherLICENSE MASSAGE THERAPIST