Provider Demographics
NPI:1649235227
Name:MONDRAGON, AUREA CARMELA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:AUREA
Middle Name:CARMELA
Last Name:MONDRAGON
Suffix:
Gender:F
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 1:4400 SW 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5526
Mailing Address - Country:US
Mailing Address - Phone:305-554-4460
Mailing Address - Fax:305-663-4442
Practice Address - Street 1:6341 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4842
Practice Address - Country:US
Practice Address - Phone:305-662-5924
Practice Address - Fax:305-663-4442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 9219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist