Derma Beauty Spa Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DERMA BEAUTY SPA MEDICAL CLINIC

Practice address

1470 NW 107TH Ave Ste M
Sweetwater, FL 33172-2735

Phone

(305) 594-5999

NPI assigned

Sep 10, 2020

Last updated

Oct 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Francie Medina

Title

Owner

Phone

(786) 454-6630

Specialties & licenses 2

Addresses

Other names 1

• Derma Beauty spa Medical Clinic Former legal business name

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602806400000",
    "number": "1285249987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 NW 107TH AVE STE M",
            "city": "SWEETWATER",
            "state": "FL",
            "postal_code": "331722735",
            "telephone_number": "305-594-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 NW 107TH AVE STE M",
            "city": "SWEETWATER",
            "state": "FL",
            "postal_code": "331722735",
            "telephone_number": "305-594-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMA BEAUTY SPA MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-10",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "FRANCIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-454-6630"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Derma Beauty spa Medical Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Derma Beauty spa Medical Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Family Medicine Physician in Sweetwater, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; 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.