Provider Demographics
NPI:1376608455
Name:RADIANCE SOUTH, PLLC
Entity Type:Organization
Organization Name:RADIANCE SOUTH, PLLC
Other - Org Name:RADIANCE MEDSPA OF SOUTH MIAMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIPAKRAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAREKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-668-4772
Mailing Address - Street 1:8440 S DIXIE HWY
Mailing Address - Street 2:RADIANCE MEDSPA
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7805
Mailing Address - Country:US
Mailing Address - Phone:305-668-4772
Mailing Address - Fax:305-668-6140
Practice Address - Street 1:8440 S DIXIE HWY
Practice Address - Street 2:RADIANCE MEDSPA
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7805
Practice Address - Country:US
Practice Address - Phone:305-668-4772
Practice Address - Fax:305-668-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty