Healthcare Provider Details

I. General information

NPI: 1871233577
Provider Name (Legal Business Name): OCEANA AESTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 SE OCEAN BLVD
STUART FL
34994-2473
US

IV. Provider business mailing address

1528 NE OUTRIGGER LANDINGS DR
JENSEN BEACH FL
34957-6506
US

V. Phone/Fax

Practice location:
  • Phone: 321-663-0301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BLUMENAUER
Title or Position: PRESIDENT
Credential: MD
Phone: 326-663-0301