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General NPI Number Information
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NPI Number | 1902696388
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Entity Type | Organization
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Legal Business Name | DIAMOND MED SPA
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 960 W 41ST ST STE 214
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3349
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Country | US
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Telephone | 305-482-1415
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Fax | 305-905-8174
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Provider Business Mailing Address
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Address Line | 960 W 41ST ST STE 214
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3349
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Country | US
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Telephone | 305-482-1415
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Fax | 305-905-8174
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Authorized Official
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Title or Position | ASSOCIATE
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Name | MATTHEW POURANI
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Credential | PA-C
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Telephone | 305-482-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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