Provider Demographics
NPI:1164690582
Name:SHINO BAY COSMETIC DERMATOLOGY & LASER INSTITUTE LLC
Entity Type:Organization
Organization Name:SHINO BAY COSMETIC DERMATOLOGY & LASER INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHINO
Authorized Official - Middle Name:B
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-765-3005
Mailing Address - Street 1:350 E LAS OLAS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-4211
Mailing Address - Country:US
Mailing Address - Phone:954-765-3005
Mailing Address - Fax:
Practice Address - Street 1:350 E LAS OLAS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4211
Practice Address - Country:US
Practice Address - Phone:954-765-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty