Healthcare Provider Details

I. General information

NPI: 1629688866
Provider Name (Legal Business Name): G LUXE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W STATE ROAD 436 STE 2013
ALTAMONTE SPRINGS FL
32714-3053
US

IV. Provider business mailing address

818 RENAISSANCE POINTE APT 201
ALTAMONTE SPRINGS FL
32714-3537
US

V. Phone/Fax

Practice location:
  • Phone: 321-710-7006
  • Fax:
Mailing address:
  • Phone: 407-844-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: STACIE HOLMES
Title or Position: OWNER
Credential:
Phone: 407-844-3205