Provider Demographics
NPI:1497053276
Name:AESTHETIC AND RECONSTRUCTIVE SURGICAL ASSOCIATES, LLC.
Entity Type:Organization
Organization Name:AESTHETIC AND RECONSTRUCTIVE SURGICAL ASSOCIATES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGERON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-471-4299
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:786-471-4299
Mailing Address - Fax:305-397-1154
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 1003
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:786-471-4299
Practice Address - Fax:305-397-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106104208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty