Healthcare Provider Details

I. General information

NPI: 1184180739
Provider Name (Legal Business Name): LUMIERE COSMETIC VEIN CENTER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 HEYDON LN STE 2
CAPE CORAL FL
33991-3550
US

IV. Provider business mailing address

2546 HEYDON LN STE 2
CAPE CORAL FL
33991-3550
US

V. Phone/Fax

Practice location:
  • Phone: 954-732-6728
  • Fax:
Mailing address:
  • Phone: 239-317-0333
  • Fax: 855-574-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH AARON CIPRIANO
Title or Position: PRESIDENT
Credential: DO
Phone: 239-317-0333