Provider Demographics
NPI:1639313281
Name:QUIJANO, YASSEL (LMT)
Entity type:Individual
Prefix:
First Name:YASSEL
Middle Name:
Last Name:QUIJANO
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 1:3550 W WATERS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2767
Mailing Address - Country:US
Mailing Address - Phone:813-374-9218
Mailing Address - Fax:813-374-9221
Practice Address - Street 1:3550 W WATERS AVE STE 108
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2767
Practice Address - Country:US
Practice Address - Phone:813-374-9218
Practice Address - Fax:813-374-9221
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53711225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist