Provider Demographics
NPI:1467015693
Name:BLUE MEDICAL SPA & RESEARCH CORP
Entity Type:Organization
Organization Name:BLUE MEDICAL SPA & RESEARCH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIROLYS
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-479-9599
Mailing Address - Street 1:330 SW 27TH AVE STE 609
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2968
Mailing Address - Country:US
Mailing Address - Phone:786-479-9599
Mailing Address - Fax:786-953-6001
Practice Address - Street 1:330 SW 27TH AVE STE 609
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2968
Practice Address - Country:US
Practice Address - Phone:786-479-9599
Practice Address - Fax:786-953-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty