| Miracle Angels Med Spa, Llc | |
|
14201 Sw 120th St Ste 205 Miami FL 33186-7663 | |
| (305) 281-2494 | |
| (305) 675-5960 |
| Full Name | Miracle Angels Med Spa, Llc |
|---|---|
| Speciality | General Practice |
| Location | 14201 Sw 120th St Ste 205, Miami, Florida |
| Authorized Official Name and Position | Yamilka Poujaud Rodriguez (OWNER) |
| Authorized Official Contact | 3052812494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracle Angels Med Spa, Llc 14201 Sw 120th St Ste 205 Miami FL 33186-7663 Ph: (305) 281-2494 | Miracle Angels Med Spa, Llc 14201 Sw 120th St Ste 205 Miami FL 33186-7663 Ph: (305) 281-2494 |
| NPI Number | 1457024994 |
|---|---|
| Provider Enumeration Date | 07/30/2021 |
| Last Update Date | 08/02/2021 |
| Medicare PECOS PAC ID | 8628476660 |
|---|---|
| Medicare Enrollment ID | O20211006001093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457024994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Arles Perdomo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1033218821 PECOS PAC ID: 8325945793 Enrollment ID: I20031215000394 |
| Provider Name | Yamilka Poujaud-rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851935308 PECOS PAC ID: 1850708306 Enrollment ID: I20210329001727 |
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