Provider Demographics
NPI:1861264939
Name:MIAMI LAKES MED SPA LLC
Entity type:Organization
Organization Name:MIAMI LAKES MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:786-873-1248
Mailing Address - Street 1:7980 NW 155TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5884
Mailing Address - Country:US
Mailing Address - Phone:305-418-0392
Mailing Address - Fax:
Practice Address - Street 1:7980 NW 155TH ST STE A
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5884
Practice Address - Country:US
Practice Address - Phone:305-418-0392
Practice Address - Fax:305-998-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care