Provider Demographics
NPI:1679047880
Name:NODAL, MELBA
Entity Type:Individual
Prefix:
First Name:MELBA
Middle Name:
Last Name:NODAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10542 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2602
Mailing Address - Country:US
Mailing Address - Phone:305-551-8329
Mailing Address - Fax:305-551-8330
Practice Address - Street 1:10542 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2602
Practice Address - Country:US
Practice Address - Phone:305-551-8329
Practice Address - Fax:305-551-8330
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA49261OtherMASSAGE THERAPIST