MEDICARE: ILIET MED & SPA 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	163WW0000X	Wound Care Registered Nurse
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1356201891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILIET MED & SPA LLC

Provider Business Mailing Address
First Line	:	1571 NW 13TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1605
Country	:	US
Telephone Number	:	786-542-7535
Fax Number	:	305-317-6604

Provider Business Practice Location Address
First Line	:	1571 NW 13TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1605
Country	:	US
Telephone Number	:	786-542-7535
Fax Number	:	305-317-6604

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ILIET HERNANDEZ
Credential	:	APRN
Telephone Number	:	786-542-7535

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	12/30/2025

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