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General NPI Number Information
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NPI Number | 1760841472
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Entity Type | Organization
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Legal Business Name | AGELESS BODY BY NEW SCIENCE LLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 2500 E HALLANDALE BEACH BLVD STE 406
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4837
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Country | US
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Telephone | 954-990-0302
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Fax | 954-908-7101
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Provider Business Mailing Address
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Address Line | 2500 E HALLANDALE BEACH BLVD STE 406
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4837
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Country | US
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Telephone | 954-990-0302
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Fax | 954-755-9347
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Authorized Official
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Title or Position | DIRECTOR
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Name | RICARDO PRESAS
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Credential | MEDICAL DOCTOR
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Telephone | 954-990-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | CH 11660
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License Number State | FL
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