Provider Demographics
NPI:1184954778
Name:BODY RENEWAL LASER CENTERS LLC
Entity type:Organization
Organization Name:BODY RENEWAL LASER CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRENES
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:941-751-2345
Mailing Address - Street 1:6815 14TH ST W STE 208
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5810
Mailing Address - Country:US
Mailing Address - Phone:941-751-2345
Mailing Address - Fax:941-751-6336
Practice Address - Street 1:6815 14TH ST W STE 208
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5810
Practice Address - Country:US
Practice Address - Phone:941-751-2345
Practice Address - Fax:941-751-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty