Provider Demographics
NPI:1750611463
Name:KEYSTONE MASSAGE & BEAUTY CLINIC, L.L.C
Entity type:Organization
Organization Name:KEYSTONE MASSAGE & BEAUTY CLINIC, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:MARITZA
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-749-0838
Mailing Address - Street 1:8331 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1608
Mailing Address - Country:US
Mailing Address - Phone:813-749-0838
Mailing Address - Fax:
Practice Address - Street 1:8331 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1608
Practice Address - Country:US
Practice Address - Phone:813-749-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center