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General NPI Number Information
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NPI Number | 1407766876
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Entity Type | Organization
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Legal Business Name | GOLD BODY MEDSPA PLLC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 1860 S BLUE ISLAND AVE STE 204
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City | CHICAGO
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State | IL
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Zip | 60608-6148
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Country | US
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Telephone | 773-340-2315
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Fax |
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Provider Business Mailing Address
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Address Line | 5206 132ND CT
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City | CRESTWOOD
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State | IL
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Zip | 60418-4443
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Country | US
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Telephone | 773-340-2315
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINA MUNOZ
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Credential |
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Telephone | 773-340-2315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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