Provider Demographics
NPI:1457041204
Name:SANOJA, NELSON SANDINO SR (LMT)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:SANDINO
Last Name:SANOJA
Suffix:SR
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 1:20230 NE 3RD CT APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5208
Mailing Address - Country:US
Mailing Address - Phone:786-523-9651
Mailing Address - Fax:
Practice Address - Street 1:900 6TH ST APT 32
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6314
Practice Address - Country:US
Practice Address - Phone:786-523-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist