Provider Demographics
NPI:1548712441
Name:URQUIZA BUSTAMANTE, YARA SILVIA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:YARA
Middle Name:SILVIA
Last Name:URQUIZA BUSTAMANTE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 SW 18TH AVE
Mailing Address - Street 2:APT 3305
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3879
Mailing Address - Country:US
Mailing Address - Phone:786-564-8257
Mailing Address - Fax:
Practice Address - Street 1:299 ALHAMBRA CIR
Practice Address - Street 2:SUITE 309
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5106
Practice Address - Country:US
Practice Address - Phone:786-967-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist