Provider Demographics
NPI:1689824716
Name:SACRAIDA, MAURO OSCAR (LMT)
Entity Type:Individual
Prefix:MR
First Name:MAURO
Middle Name:OSCAR
Last Name:SACRAIDA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 ROOKERY BAY DR
Mailing Address - Street 2:2104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-9323
Mailing Address - Country:US
Mailing Address - Phone:239-272-3795
Mailing Address - Fax:
Practice Address - Street 1:2048 ROOKERY BAY DR
Practice Address - Street 2:2104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-9323
Practice Address - Country:US
Practice Address - Phone:239-272-3795
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
FLMA45899225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist