Provider Demographics
NPI:1538447768
Name:LAMBERT, JOSE A
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:11373 W FLAGLER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4205
Mailing Address - Country:US
Mailing Address - Phone:305-220-2755
Mailing Address - Fax:305-220-2798
Practice Address - Street 1:11373 W FLAGLER ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4205
Practice Address - Country:US
Practice Address - Phone:305-220-2755
Practice Address - Fax:305-220-2798
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62191171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45-1687799OtherMASSAGE THERAPIST