Provider Demographics
NPI:1033546155
Name:COSMETIC SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:COSMETIC SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIZETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-297-0623
Mailing Address - Street 1:13055 SW 42ND ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3406
Mailing Address - Country:US
Mailing Address - Phone:305-228-8380
Mailing Address - Fax:305-228-8371
Practice Address - Street 1:13055 SW 42ND ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3406
Practice Address - Country:US
Practice Address - Phone:305-228-8300
Practice Address - Fax:305-228-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOSR541261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID