Provider Demographics
NPI:1669531547
Name:FARINAS, JACQUELINE A
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:FARINAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 GRAND CANAL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2561
Mailing Address - Country:US
Mailing Address - Phone:305-262-8863
Mailing Address - Fax:305-262-8804
Practice Address - Street 1:85 GRAND CANAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2561
Practice Address - Country:US
Practice Address - Phone:305-262-8863
Practice Address - Fax:305-262-8804
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 2909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4833AMedicare ID - Type Unspecified