Provider Demographics
NPI:1285907220
Name:LACERNA AESTHETIC REJUVENATION, INC
Entity type:Organization
Organization Name:LACERNA AESTHETIC REJUVENATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LACERNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-954-4500
Mailing Address - Street 1:1274 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5604
Mailing Address - Country:US
Mailing Address - Phone:941-954-4500
Mailing Address - Fax:941-954-4555
Practice Address - Street 1:1274 N PALM AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5604
Practice Address - Country:US
Practice Address - Phone:941-954-4500
Practice Address - Fax:941-954-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty