Provider Demographics
NPI:1891003752
Name:ZULUETA, JOSE M (MA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:ZULUETA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13903 NW 67TH AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2938
Mailing Address - Country:US
Mailing Address - Phone:786-439-3996
Mailing Address - Fax:786-439-3997
Practice Address - Street 1:13903 NW 67TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-2938
Practice Address - Country:US
Practice Address - Phone:786-439-3996
Practice Address - Fax:786-439-3997
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 39065225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27 2113636OtherMASSAGE THERAPY