Provider Demographics
NPI:1689943151
Name:CANGAS, OLGA LIDIA (CEO)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:LIDIA
Last Name:CANGAS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19251 SW 134 AVENUE ROAD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0000
Mailing Address - Country:US
Mailing Address - Phone:786-506-1455
Mailing Address - Fax:
Practice Address - Street 1:19251 SW 134 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-0000
Practice Address - Country:US
Practice Address - Phone:786-506-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65476225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist