Healthcare Provider Details

I. General information

NPI: 1760841472
Provider Name (Legal Business Name): AGELESS BODY BY NEW SCIENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E HALLANDALE BEACH BLVD STE 406
HALLANDALE BEACH FL
33009-4837
US

IV. Provider business mailing address

2500 E HALLANDALE BEACH BLVD STE 406
HALLANDALE BEACH FL
33009-4837
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-0302
  • Fax: 954-908-7101
Mailing address:
  • Phone: 954-990-0302
  • Fax: 954-755-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH 11660
License Number StateFL

VIII. Authorized Official

Name: RICARDO PRESAS
Title or Position: DIRECTOR
Credential: MEDICAL DOCTOR
Phone: 954-990-0302