Provider Demographics
NPI:1952929978
Name:FABIAN ENAYTZADAH, ORA (LMT)
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:
Last Name:FABIAN ENAYTZADAH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ORA
Other - Middle Name:
Other - Last Name:ENAYTZADAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 800448
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33280-0448
Mailing Address - Country:US
Mailing Address - Phone:754-244-9974
Mailing Address - Fax:
Practice Address - Street 1:723 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32314-8602
Practice Address - Country:US
Practice Address - Phone:754-244-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist