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General NPI Number Information
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NPI Number | 1124695507
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Entity Type | Organization
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Legal Business Name | MARQUESA AESTHETICS LLC (CRANIAL PROSTHESIS)
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Dates
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Enumeration Date | 06/05/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 2590 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33133-3137
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Country | US
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Telephone | 305-444-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 2590 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33133-3137
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Country | US
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Telephone | 305-444-4444
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. LORENZO LORENZO
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Credential | MBA
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Telephone | 305-444-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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