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General NPI Number Information
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NPI Number | 1356201891
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Entity Type | Organization
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Legal Business Name | ILIET MED & SPA LLC
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1571 NW 13TH CT
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City | MIAMI
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State | FL
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Zip | 33125-1605
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Country | US
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Telephone | 786-542-7535
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Fax | 305-317-6604
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Provider Business Mailing Address
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Address Line | 1571 NW 13TH CT
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City | MIAMI
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State | FL
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Zip | 33125-1605
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Country | US
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Telephone | 786-542-7535
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Fax | 305-317-6604
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ILIET HERNANDEZ
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Credential | APRN
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Telephone | 786-542-7535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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