Lavernia Medi-Spa, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

HCC5400 Issued in FL

Legal business name

LAVERNIA MEDI-SPA, INC.

Practice address

7902 N.W. 36 Street
Suite 201
Miami, FL 33166

Phone

(305) 629-9662

Fax

(305) 629-9663

NPI assigned

Nov 6, 2006

Last updated

Aug 22, 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

Mr. Pedro L Puebla

Title

President

Phone

(305) 629-9662

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689753030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7902 N.W. 36 STREET",
            "address_2": "201",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "33166",
            "telephone_number": "305-629-9662",
            "fax_number": "305-629-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7902 N.W. 36 STREET",
            "address_2": "SUITE 201",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33166",
            "telephone_number": "305-629-9662",
            "fax_number": "305-629-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVERNIA MEDI-SPA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PUEBLA",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-629-9662",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "HCC5400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA LICENSE",
            "identifier": "HCC5400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lavender Physical Therapy & Wellness, LLC
• Lavender Psychiatry
• Martha Laverde Castro
• Jessica Laverde-Perez
• Julian Laverde, LMHC
• Carlos Jesus Lavernia, M.D.
• Gloria Esther Lavernia, PHARMD
• Dennis G Laveroni, PHARM.D.
• David Clay Lavery, RCS,RVS
• Lester Lavin, B.S

• Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.