Provider Demographics
NPI:1700033545
Name:GIRALDEZ, SERGIO (LMT)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:GIRALDEZ
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 1:6555 NW 36TH ST
Mailing Address - Street 2:# 118
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6978
Mailing Address - Country:US
Mailing Address - Phone:305-874-2288
Mailing Address - Fax:305-874-2200
Practice Address - Street 1:6555 NW 36TH ST
Practice Address - Street 2:# 118
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6978
Practice Address - Country:US
Practice Address - Phone:305-874-2288
Practice Address - Fax:305-874-2200
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 11198173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA