MEDICARE: AQUA BEAUTY AND BODY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1346116548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AQUA BEAUTY AND BODY LLC

Provider Business Mailing Address
First Line	:	4715 NW 157TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6435
Country	:	US
Telephone Number	:	305-813-3700
Fax Number	:	305-813-3700

Provider Business Practice Location Address
First Line	:	4715 NW 157TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6435
Country	:	US
Telephone Number	:	305-813-3700
Fax Number	:	305-813-3700

Authorized Official
Title or Position	:	OWNER
Name	:	BRIGITTE GUILLOTTI
Credential	:
Telephone Number	:	305-813-3700

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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