Provider Demographics
NPI:1982904827
Name:ARENCIBIA-HERNANDEZ, JUAN M (LMT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:ARENCIBIA-HERNANDEZ
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 1:1140 W 50TH ST
Mailing Address - Street 2:SUITE#202
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3440
Mailing Address - Country:US
Mailing Address - Phone:786-362-5830
Mailing Address - Fax:786-362-5892
Practice Address - Street 1:1140 W 50TH ST
Practice Address - Street 2:SUITE#202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3440
Practice Address - Country:US
Practice Address - Phone:786-362-5830
Practice Address - Fax:786-362-5892
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist