Provider Demographics
NPI:1174137582
Name:VERDECIA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VERDECIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W 26TH PL APT 103
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1003
Mailing Address - Country:US
Mailing Address - Phone:786-454-6652
Mailing Address - Fax:
Practice Address - Street 1:1305 W 26TH PL APT 103
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1003
Practice Address - Country:US
Practice Address - Phone:786-454-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62284225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist