Provider Demographics
NPI:1932871464
Name:GUNDIN DE FREITAS E DAMAS, VIVIANE (LMT, NMT, CHMLDT)
Entity type:Individual
Prefix:
First Name:VIVIANE
Middle Name:
Last Name:GUNDIN DE FREITAS E DAMAS
Suffix:
Gender:F
Credentials:LMT, NMT, CHMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 NW 7TH ST APT 404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4474
Mailing Address - Country:US
Mailing Address - Phone:305-510-0889
Mailing Address - Fax:
Practice Address - Street 1:6560 NW 7TH ST APT 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4474
Practice Address - Country:US
Practice Address - Phone:305-510-0889
Practice Address - Fax:770-691-5064
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist