Provider Demographics
NPI:1548021314
Name:MEDSPA & PRIMARY CARE LLC
Entity type:Organization
Organization Name:MEDSPA & PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:AHITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRAZANA ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-230-8163
Mailing Address - Street 1:825 E COWBOY WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4491
Mailing Address - Country:US
Mailing Address - Phone:863-230-8163
Mailing Address - Fax:863-230-8273
Practice Address - Street 1:825 E COWBOY WAY STE 106
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4491
Practice Address - Country:US
Practice Address - Phone:863-230-8163
Practice Address - Fax:863-230-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service