Provider Demographics
NPI:1902696388
Name:DIAMOND MED SPA
Entity type:Organization
Organization Name:DIAMOND MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:POURANI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:305-482-1415
Mailing Address - Street 1:960 W 41ST ST STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3349
Mailing Address - Country:US
Mailing Address - Phone:305-482-1415
Mailing Address - Fax:305-905-8174
Practice Address - Street 1:960 W 41ST ST STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3349
Practice Address - Country:US
Practice Address - Phone:305-482-1415
Practice Address - Fax:305-905-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center