Healthcare Provider Details

I. General information

NPI: 1770855843
Provider Name (Legal Business Name): DR. CUBAS WEIGHT LOSS CENTER AND SPA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 S FLAMINGO RD
PEMBROKE PINES FL
33027-1768
US

IV. Provider business mailing address

6870 DYKES RD
SOUTHWEST RANCHES FL
33331-4663
US

V. Phone/Fax

Practice location:
  • Phone: 954-434-1010
  • Fax: 954-434-1730
Mailing address:
  • Phone: 954-434-1010
  • Fax: 954-434-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME56199
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberME56199
License Number StateFL

VIII. Authorized Official

Name: DR. FELIPE CUBAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-434-1010