Provider Demographics
NPI:1821892373
Name:HEREDIA, FELIXMAR ROSALIN
Entity type:Individual
Prefix:
First Name:FELIXMAR
Middle Name:ROSALIN
Last Name:HEREDIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SAND LAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7671
Mailing Address - Country:US
Mailing Address - Phone:786-552-2431
Mailing Address - Fax:
Practice Address - Street 1:1650 SAND LAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7671
Practice Address - Country:US
Practice Address - Phone:786-552-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101063225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist