Destiny Med Spa Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

DESTINY MED SPA INC

Practice address

5636 NW 167TH St
Miami Lakes, FL 33014-6135

Phone

(305) 800-5476

NPI assigned

Aug 1, 2026

Organization subpart

No

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

Authorized official

Name

Edna Viviana Ayala

Title

Owner

Phone

(786) 444-6589

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1785542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1962325472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5636 NW 167TH ST",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330146135",
            "telephone_number": "305-800-5476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5636 NW 167TH ST",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330146135",
            "telephone_number": "305-800-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY MED SPA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-01",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "AYALA",
        "authorized_official_first_name": "EDNA",
        "authorized_official_middle_name": "VIVIANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-444-6589"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; 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.