Provider Demographics
NPI:1528790573
Name:MADRIZ, KEREN
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:MADRIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 S VOLUSIA AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7626
Mailing Address - Country:US
Mailing Address - Phone:407-690-7696
Mailing Address - Fax:407-610-0287
Practice Address - Street 1:2445 S VOLUSIA AVE STE C4
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7626
Practice Address - Country:US
Practice Address - Phone:407-690-7696
Practice Address - Fax:407-610-0287
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist