Provider Demographics
NPI:1578882197
Name:SAN MICHAEL COSMETICS, LLC
Entity Type:Organization
Organization Name:SAN MICHAEL COSMETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGUIH
Authorized Official - Middle Name:
Authorized Official - Last Name:EL MASRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-535-6400
Mailing Address - Street 1:1960 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2218
Mailing Address - Country:US
Mailing Address - Phone:727-535-6400
Mailing Address - Fax:
Practice Address - Street 1:1960 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2218
Practice Address - Country:US
Practice Address - Phone:727-535-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty