Provider Demographics
NPI:1669215547
Name:FLORIDA AESTHETICS AND COMPREHENSIVE THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:FLORIDA AESTHETICS AND COMPREHENSIVE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-698-3688
Mailing Address - Street 1:9100 SW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4330
Mailing Address - Country:US
Mailing Address - Phone:786-928-0174
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE STE 600
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4728
Practice Address - Country:US
Practice Address - Phone:786-928-0174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty