Healthcare Provider Details

I. General information

NPI: 1104756105
Provider Name (Legal Business Name): EFIGIE MED SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SW 87TH AVE STE 206
MIAMI FL
33165-3264
US

IV. Provider business mailing address

2750 SW 87TH AVE STE 206
MIAMI FL
33165-3264
US

V. Phone/Fax

Practice location:
  • Phone: 305-954-1963
  • Fax:
Mailing address:
  • Phone: 305-954-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number State

VIII. Authorized Official

Name: RICARDO CASTRELLON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-954-1963