Healthcare Provider Details

I. General information

NPI: 1366223570
Provider Name (Legal Business Name): OPTIMAL AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 WESTSHORE PLAZA TAMPA, FL 33609 WEST SHORE MALL . STE. C12
TAMPA FL
33609
US

IV. Provider business mailing address

273 WESTSHORE PLZ # C12
TAMPA FL
33609-1810
US

V. Phone/Fax

Practice location:
  • Phone: 813-244-0528
  • Fax:
Mailing address:
  • Phone: 813-244-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO GARRIDO
Title or Position: OWNER/ PROVIDER
Credential: PA-C
Phone: 813-240-3388