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General NPI Number Information
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NPI Number | 1730493974
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Entity Type | Organization
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Legal Business Name | PECANS DAY SPA INC.
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 7800 SW 57TH AVE STE 120
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5543
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Country | US
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Telephone | 305-284-8636
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Fax | 305-661-0550
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Provider Business Mailing Address
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Address Line | 7800 SW 57TH AVE STE 120
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5543
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Country | US
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Telephone | 305-284-8636
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Fax | 305-661-0550
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DONALD SCOTT VOROUS
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Credential | LMT
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Telephone | 305-284-8636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | MA31962
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License Number State | FL
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