Provider Demographics
NPI:1952639254
Name:SOLUNA AESTHETIC CENTER, PLLC
Entity Type:Organization
Organization Name:SOLUNA AESTHETIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORIATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-446-0440
Mailing Address - Street 1:10185 COLLINS AVE
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1600
Mailing Address - Country:US
Mailing Address - Phone:305-446-0440
Mailing Address - Fax:305-446-0431
Practice Address - Street 1:4251 SALZEDO ST
Practice Address - Street 2:SUITE 1330
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1453
Practice Address - Country:US
Practice Address - Phone:305-446-0440
Practice Address - Fax:305-446-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty