Leaf It Up Medspa,LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME107216 Issued in FL

Legal business name

LEAF IT UP MEDSPA,LLC

Practice address

1000 N Broadwalk Ste 1
Hollywood, FL 33019-1221

Phone

(954) 391-9869

Fax

(954) 573-6505

NPI assigned

Mar 29, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ivel Cristina De Freitas, MD

Title

Medical Director

Phone

(954) 391-9869

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1003159963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N BROADWALK STE 1",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330191221",
            "telephone_number": "954-391-9869",
            "fax_number": "954-573-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N BROADWALK STE 1",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330191221",
            "telephone_number": "954-391-9869",
            "fax_number": "954-573-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAF IT UP MEDSPA,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "DE FREITAS",
        "authorized_official_first_name": "IVEL",
        "authorized_official_middle_name": "CRISTINA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "954-391-9869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME107216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.