Provider Demographics
NPI:1407325228
Name:FLORIDA COSMETIC CENTER LLC
Entity Type:Organization
Organization Name:FLORIDA COSMETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:G
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-922-2421
Mailing Address - Street 1:1420 CELEBRATION BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5161
Mailing Address - Country:US
Mailing Address - Phone:407-922-2421
Mailing Address - Fax:321-939-4069
Practice Address - Street 1:1420 CELEBRATION BLVD STE 314
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-5161
Practice Address - Country:US
Practice Address - Phone:407-922-2421
Practice Address - Fax:321-939-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN