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General NPI Number Information
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NPI Number | 1043480759
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Entity Type | Organization
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Legal Business Name | MD BEAUTY LABS PA
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 320 S. QUADRILLE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3404
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Country | US
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Telephone | 561-655-6325
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Fax | 561-366-1198
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Provider Business Mailing Address
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Address Line | 320 S. QUADRILLE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3404
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Country | US
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Telephone | 561-655-6325
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Fax | 561-366-1198
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIELA DADURIAN
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Credential | M.D.
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Telephone | 561-655-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME70074
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License Number State | FL
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