Healthcare Provider Details

I. General information

NPI: 1649588039
Provider Name (Legal Business Name): MDSPAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 12/15/2010
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:
Mailing address:
  • Phone: 305-444-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME 71711
License Number StateFL

VIII. Authorized Official

Name: PATRICK Z ABUZENI
Title or Position: PRESISENT
Credential:
Phone: 305-444-2888