Provider Demographics
NPI:1730493974
Name:PECANS DAY SPA INC.
Entity Type:Organization
Organization Name:PECANS DAY SPA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VOROUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-284-8636
Mailing Address - Street 1:7800 SW 57TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5543
Mailing Address - Country:US
Mailing Address - Phone:305-284-8636
Mailing Address - Fax:305-661-0550
Practice Address - Street 1:7800 SW 57TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5543
Practice Address - Country:US
Practice Address - Phone:305-284-8636
Practice Address - Fax:305-661-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31962171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty