Healthcare Provider Details

I. General information

NPI: 1093933145
Provider Name (Legal Business Name): MD SPAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PALERMO AVE
CORAL GABLES FL
33134-6606
US

IV. Provider business mailing address

248 PALERMO AVE
CORAL GABLES FL
33134-6606
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-2888
  • Fax: 305-444-2333
Mailing address:
  • Phone: 305-444-2888
  • Fax: 305-444-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5527941
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICK ABUZENI
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 30544482888