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General NPI Number Information
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NPI Number | 1841051752
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Entity Type | Organization
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Legal Business Name | SECRETS AESTHETICS AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 7601 WINDERMERE CONROY RD STE 202
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City | ORLANDO
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State | FL
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Zip | 32835-2688
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Country | US
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Telephone | 407-775-2845
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 WINDERMERE CONROY RD STE 202
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City | ORLANDO
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State | FL
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Zip | 32835-2688
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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 | BUSINESS MANAGER
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Name | JOHN DISTEFANO
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Credential |
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Telephone | 352-317-3214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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