Provider Demographics
NPI:1275122087
Name:LLORENTE, MARICELYS (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARICELYS
Middle Name:
Last Name:LLORENTE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8755 SW 24TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2005
Mailing Address - Country:US
Mailing Address - Phone:305-475-9999
Mailing Address - Fax:786-530-4227
Practice Address - Street 1:8755 SW 24TH ST STE A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2005
Practice Address - Country:US
Practice Address - Phone:305-475-9999
Practice Address - Fax:786-530-4027
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty