Healthcare Provider Details

I. General information

NPI: 1063787844
Provider Name (Legal Business Name): USVI MEDICAL DAY SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 RAPHUNE HILL RD SUITE 108
ST THOMAS VI
00802-2905
US

IV. Provider business mailing address

4001 RAPHUNE HILL RD SUITE 108
ST THOMAS VI
00802-2905
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-2331
  • Fax: 340-774-2353
Mailing address:
  • Phone: 340-774-2331
  • Fax: 340-774-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN D WALLACE
Title or Position: MEMBER
Credential:
Phone: 316-258-3817