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General NPI Number Information
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NPI Number | 1750198412
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Entity Type | Organization
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Legal Business Name | BOSSY AESTHETICS LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 6811 MAIN ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2047
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Country | US
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Telephone | 786-914-3362
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Fax |
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Provider Business Mailing Address
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Address Line | 6835 W 10TH AVE
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City | HIALEAH
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State | FL
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Zip | 33014-5201
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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 | JULIETE MISAS HERNANDEZ
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Credential | ARNP
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Telephone | 786-447-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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