Healthcare Provider Details

I. General information

NPI: 1417721325
Provider Name (Legal Business Name): BLUE D CLASS MEDSPA & THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 NW 7 STREET
MIAMI FL
33125-4203
US

IV. Provider business mailing address

3009 NW 7 STREET
MIAMI FL
33125-4203
US

V. Phone/Fax

Practice location:
  • Phone: 786-963-5892
  • Fax: 305-489-6456
Mailing address:
  • Phone: 786-963-5892
  • Fax: 305-489-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YOANDRA RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-963-5892