# DERMA BEAUTY SPA MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Derma Beauty spa Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285249987
- **Authorized official:** FRANCIE MEDINA (OWNER)
- **Authorized official phone:** (786) 454-6630

## Contact information

- **Practice address:** 1470 NW 107TH AVE STE M, SWEETWATER, FL 33172-2735
- **Practice address phone:** (305) 594-5999
- **Mailing address:** 1470 NW 107TH AVE STE M, SWEETWATER, FL 33172-2735
- **Mailing address phone:** (305) 594-5999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/10/2020
- **Last updated:** 10/16/2020