| Miami Lakes Med Spa Llc | |
|
7980 Nw 155th St Ste A Miami Lakes FL 33016-5884 | |
| (305) 418-0392 | |
| (305) 998-1456 |
| Full Name | Miami Lakes Med Spa Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7980 Nw 155th St Ste A, Miami Lakes, Florida |
| Authorized Official Name and Position | Armando Gonzalez (OWNER) |
| Authorized Official Contact | 7868731248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miami Lakes Med Spa Llc 7980 Nw 155th St Ste A Miami Lakes FL 33016-5884 Ph: (305) 418-0392 | Miami Lakes Med Spa Llc 7980 Nw 155th St Ste A Miami Lakes FL 33016-5884 Ph: (305) 418-0392 |
| NPI Number | 1861264939 |
|---|---|
| Provider Enumeration Date | 10/23/2023 |
| Last Update Date | 10/23/2023 |
| Medicare PECOS PAC ID | 2860841780 |
|---|---|
| Medicare Enrollment ID | O20231218000753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861264939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Sabrina Elyz Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972159408 PECOS PAC ID: 6406205327 Enrollment ID: I20231218000825 |
| Provider Name | Armando Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558883744 PECOS PAC ID: 4688023500 Enrollment ID: I20231218000918 |
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