Provider Demographics
NPI:1033788443
Name:ALEXANDER MEDICAL SPA, PA
Entity Type:Organization
Organization Name:ALEXANDER MEDICAL SPA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:305-962-1789
Mailing Address - Street 1:3363 NE 163RD ST STE 505
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4423
Mailing Address - Country:US
Mailing Address - Phone:786-801-3122
Mailing Address - Fax:305-513-5214
Practice Address - Street 1:3363 NE 163RD ST STE 505
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4423
Practice Address - Country:US
Practice Address - Phone:786-801-3122
Practice Address - Fax:305-513-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty