Provider Demographics
NPI:1285012773
Name:BE BELLUS MED SPA
Entity Type:Organization
Organization Name:BE BELLUS MED SPA
Other - Org Name:BE BELLUS WELLNESS & AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:FEANANDA
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-963-2888
Mailing Address - Street 1:6914 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-963-2888
Mailing Address - Fax:813-200-1008
Practice Address - Street 1:6914 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-963-2888
Practice Address - Fax:813-200-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center