1316551013 NPI number — MS. RANDI NINA WEST LMT, CMLDT

Table of content: MS. RANDI NINA WEST LMT, CMLDT (NPI 1316551013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316551013 NPI number — MS. RANDI NINA WEST LMT, CMLDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
RANDI
Provider Middle Name:
NINA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT, CMLDT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEST
Provider Other First Name:
RANDI
Provider Other Middle Name:
NINA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT, CMLDT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316551013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 THREE ISLANDS BLVD APT 1004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-467-3024
Provider Business Mailing Address Fax Number:
954-251-3578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3532 N OCEAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-6752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-467-3024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA-51104 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0289955556 . This is a "MASSAGE LIABILITY INSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".