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General NPI Number Information
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NPI Number | 1952639254
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Entity Type | Organization
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Legal Business Name | SOLUNA AESTHETIC CENTER, PLLC
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 4251 SALZEDO ST SUITE 1330
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City | CORAL GABLES
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State | FL
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Zip | 33146-1453
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Country | US
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Telephone | 305-446-0440
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Fax | 305-446-0431
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Provider Business Mailing Address
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Address Line | 10185 COLLINS AVE SUITE 1208
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City | BAL HARBOUR
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State | FL
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Zip | 33154-1600
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Country | US
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Telephone | 305-446-0440
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Fax | 305-446-0431
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ALAN KHORIATY
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Credential |
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Telephone | 305-446-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number |
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License Number State |
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