Provider Demographics
NPI:1326295635
Name:KERASTASE SERVICE CENTER CORP.
Entity Type:Organization
Organization Name:KERASTASE SERVICE CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:GEHRKE
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-222-1384
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:SUITE 587
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:786-222-1384
Mailing Address - Fax:786-222-1385
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:SUITE 587
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:786-222-1384
Practice Address - Fax:786-222-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies