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General NPI Number Information
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NPI Number | 1861382376
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Entity Type | Organization
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Legal Business Name | EOS REGENERATIVE AESTHETIC MEDICINE
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 2059 CENTRAL AVE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8814
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Country | US
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Telephone | 813-789-3464
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Fax |
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Provider Business Mailing Address
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Address Line | 2059 CENTRAL AVE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8814
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Country | US
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Telephone | 813-789-3464
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | STACY RIBEIRO
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Credential |
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Telephone | 813-510-0096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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