Provider Demographics
NPI:1851733976
Name:TRUE RADIANCE MEDISPA
Entity Type:Organization
Organization Name:TRUE RADIANCE MEDISPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LLAMADO
Authorized Official - Last Name:YAP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:252-969-0025
Mailing Address - Street 1:800 TIFFANY BLVD STE 100B
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1807
Mailing Address - Country:US
Mailing Address - Phone:252-969-0025
Mailing Address - Fax:
Practice Address - Street 1:800 TIFFANY BLVD STE 100B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1807
Practice Address - Country:US
Practice Address - Phone:252-969-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1891822391208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty