Provider Demographics
NPI:1952044554
Name:LUXURY THERAPY MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:LUXURY THERAPY MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YIDIER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO GIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-663-7276
Mailing Address - Street 1:10541 W 32ND LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2113
Mailing Address - Country:US
Mailing Address - Phone:786-970-7130
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 517
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2950
Practice Address - Country:US
Practice Address - Phone:786-663-7276
Practice Address - Fax:305-397-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty