Provider Demographics
NPI:1396049920
Name:OBREGON, LUIS M (LMT NCBTMB)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:M
Last Name:OBREGON
Suffix:
Gender:M
Credentials:LMT NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9349 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4148
Mailing Address - Country:US
Mailing Address - Phone:305-401-4029
Mailing Address - Fax:305-207-8254
Practice Address - Street 1:9349 SW 39TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4148
Practice Address - Country:US
Practice Address - Phone:305-401-4029
Practice Address - Fax:305-207-8254
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59106225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist