Provider Demographics
NPI:1912280231
Name:URTEAGA, CARLOS LUIS (LMT)
Entity Type:Individual
Prefix:
First Name:CARLOS LUIS
Middle Name:
Last Name:URTEAGA
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 1:7000 SW 87TH CT
Mailing Address - Street 2:APT. 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2526
Mailing Address - Country:US
Mailing Address - Phone:786-752-0135
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 87TH CT
Practice Address - Street 2:APT. 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2526
Practice Address - Country:US
Practice Address - Phone:786-752-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist