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General NPI Number Information
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NPI Number | 1366223570
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Entity Type | Organization
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Legal Business Name | OPTIMAL AESTHETICS, LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 273 WESTSHORE PLAZA TAMPA, FL 33609 WEST SHORE MALL . STE. C12
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City | TAMPA
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State | FL
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Zip | 33609
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Country | US
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Telephone | 813-244-0528
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Fax |
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Provider Business Mailing Address
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Address Line | 273 WESTSHORE PLZ # C12
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City | TAMPA
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State | FL
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Zip | 33609-1810
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Country | US
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Telephone | 813-244-0528
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | EDUARDO GARRIDO
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Credential | PA-C
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Telephone | 813-240-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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