Healthcare Provider Details

I. General information

NPI: 1386173987
Provider Name (Legal Business Name): PERFECT LEGS VEIN SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W FLAGLER ST
MIAMI FL
33135
US

IV. Provider business mailing address

3080 W FLAGLER ST
MIAMI FL
33135-1227
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-3315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberHCC10637
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberHCC10637
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberHCC10637
License Number StateFL

VIII. Authorized Official

Name: DALYS DEL CARMEN CASTANEDAS
Title or Position: PRESIDENT
Credential:
Phone: 786-360-3315