Provider Demographics
NPI:1629365804
Name:ZALDIVAR, ANDREZA (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREZA
Middle Name:
Last Name:ZALDIVAR
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 1:8001 W 26TH AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2753
Mailing Address - Country:US
Mailing Address - Phone:305-646-1023
Mailing Address - Fax:
Practice Address - Street 1:8001 W 26TH AVE UNIT 11
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2753
Practice Address - Country:US
Practice Address - Phone:305-646-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60073225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist