Provider Demographics
NPI:1396063483
Name:VEGA ENAMORADO, PEDRO (MA)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:VEGA ENAMORADO
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 1:9180 SW 203RD TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1855
Mailing Address - Country:US
Mailing Address - Phone:786-389-6003
Mailing Address - Fax:305-253-6193
Practice Address - Street 1:9180 SW 203RD TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1855
Practice Address - Country:US
Practice Address - Phone:786-389-6003
Practice Address - Fax:305-253-6193
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56236225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist