Healthcare Provider Details

I. General information

NPI: 1003412180
Provider Name (Legal Business Name): P31 ARTISTRY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2020
Last Update Date: 01/24/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 10TH ST # 1427
LAKE PARK FL
33403-2041
US

IV. Provider business mailing address

1427 10TH ST # 1427
LAKE PARK FL
33403-2041
US

V. Phone/Fax

Practice location:
  • Phone: 561-469-9857
  • Fax:
Mailing address:
  • Phone: 561-469-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: JUDY S CARASCO
Title or Position: HAIR LOSS PRACTITIONER
Credential: HLP
Phone: 561-889-1819