Healthcare Provider Details
I. General information
NPI: 1265265086
Provider Name (Legal Business Name): MEN'S ONLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
625 N FLAGLER DR
WEST PALM BEACH FL
33401-4027
US
IV. Provider business mailing address
625 N FLAGLER DR
WEST PALM BEACH FL
33401-4027
US
V. Phone/Fax
- Phone: 561-870-7254
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207QA0505X |
| Taxonomy | Adult Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ALEJANDRO
LUIS
MIQUEL
Title or Position: OWNER
Credential: MD
Phone: 561-870-7254