Healthcare Provider Details

I. General information

NPI: 1558228924
Provider Name (Legal Business Name): ELITE BEAUTY MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 SW 87TH AVE
MIAMI FL
33174-3206
US

IV. Provider business mailing address

911 SW 87TH AVE
MIAMI FL
33174-3206
US

V. Phone/Fax

Practice location:
  • Phone: 305-988-8260
  • Fax: 786-686-9175
Mailing address:
  • Phone: 305-988-8260
  • Fax: 786-686-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORENA RESTREPO
Title or Position: PRESIDENT
Credential: APRN
Phone: 305-988-8260