Healthcare Provider Details

I. General information

NPI: 1487558045
Provider Name (Legal Business Name): LIDIA'S SKIN AND BODY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WILSON BLVD OFC 52
ARLINGTON VA
22209-2464
US

IV. Provider business mailing address

1408 N MEADE ST
ARLINGTON VA
22209-3703
US

V. Phone/Fax

Practice location:
  • Phone: 201-757-3198
  • Fax:
Mailing address:
  • Phone: 201-757-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LIDIA CICERELLO
Title or Position: OWNER
Credential:
Phone: 201-757-3198