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General NPI Number Information
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NPI Number | 1669979407
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Entity Type | Organization
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Legal Business Name | VENUS MOBILE MEDSPA
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 3501 S TAMIAMI TRL STE 307
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City | SARASOTA
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State | FL
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Zip | 34239-6109
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Country | US
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Telephone | 941-232-7191
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 S TAMIAMI TRL STE 307
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City | SARASOTA
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State | FL
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Zip | 34239-6109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BILL CLARKE
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Credential |
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Telephone | 239-839-8391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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