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Organization
ANTI AGING AESTHETIC AND LASER CENTER INC
Active
Organization
ANTI AGING AESTHETIC AND LASER CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLEG RYBAK (OWNER/PRESIDENT)
(786) 539-4901
Entity
Organization
Contact information
Practice address
175 SW 7TH ST, SUITE 1710, MIAMI, FL 33130-2992
(786) 539-4901
(786) 539-4904
Mailing address
175 SW 7TH ST, SUITE 1710, MIAMI, FL 33130-2992
(786) 539-4901
(786) 539-4904
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
208D00000X
General Practice Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSR 674
FL
261QM1300X
Multi-Specialty Clinic/Center
HCC8118
FL
Other
Enumeration date
04/07/2010
Last updated
09/08/2010
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