Provider Demographics
NPI:1972003515
Name:IZQUIERDO, JAIME (LMT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:IZQUIERDO
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 1:1005 SHORE LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2445
Mailing Address - Country:US
Mailing Address - Phone:305-788-3093
Mailing Address - Fax:
Practice Address - Street 1:1005 SHORE LN
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2445
Practice Address - Country:US
Practice Address - Phone:305-788-3093
Practice Address - Fax:305-788-3093
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73616225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty