Healthcare Provider Details

I. General information

NPI: 1235829326
Provider Name (Legal Business Name): LYF AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 S DIXIE HWY STE 403
PALMETTO BAY FL
33176-7954
US

IV. Provider business mailing address

14707 S DIXIE HWY STE 403
PALMETTO BAY FL
33176-7954
US

V. Phone/Fax

Practice location:
  • Phone: 305-614-2088
  • Fax:
Mailing address:
  • Phone: 305-614-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO CEPERO
Title or Position: CEO
Credential:
Phone: 305-300-8788