Provider Demographics
NPI:1861238636
Name:ESTETICA BUENA VIDA, INC.
Entity type:Organization
Organization Name:ESTETICA BUENA VIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AXEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:787-478-9286
Mailing Address - Street 1:94 CALLE FRANCISCO GALANES
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5214
Mailing Address - Country:US
Mailing Address - Phone:787-313-3551
Mailing Address - Fax:
Practice Address - Street 1:142 CARR 102 # KM18.8
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3138
Practice Address - Country:US
Practice Address - Phone:787-313-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty