Provider Demographics
NPI:1134154057
Name:ISAZA, MARIA FERNANDA JR (OT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:ISAZA
Suffix:JR
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14003 SW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5996
Mailing Address - Country:US
Mailing Address - Phone:786-718-5669
Mailing Address - Fax:
Practice Address - Street 1:12151 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1957
Practice Address - Country:US
Practice Address - Phone:786-718-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2188Medicare PIN