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General NPI Number Information
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NPI Number | 1720891955
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Entity Type | Organization
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Legal Business Name | MEDGLAM AESTHETICS LLC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 2605 YOUNTVILLE AVE
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City | KISSIMMEE
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State | FL
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Zip | 34741
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Country | US
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Telephone | 786-566-0967
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 DYER BLVD STE 181
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City | KISSIMMEE
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State | FL
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Zip | 34741-7839
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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 | NURSE PRACTITIONER
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Name | CANDISE CECILIA CABADO
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Credential | NP
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Telephone | 786-566-0967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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