Provider Demographics
NPI:1558722892
Name:SIMPLICITI MEDSPA LLC
Entity Type:Organization
Organization Name:SIMPLICITI MEDSPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-448-6070
Mailing Address - Street 1:8292 OLD COURTHOUSE RD STE C
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3864
Mailing Address - Country:US
Mailing Address - Phone:703-448-6070
Mailing Address - Fax:703-448-1049
Practice Address - Street 1:8292 OLD COURTHOUSE RD STE C
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3864
Practice Address - Country:US
Practice Address - Phone:703-448-6070
Practice Address - Fax:703-448-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236981207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty