# JL LARIA APRN PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Laria Medspa
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417562414
- **Authorized official:** JOSE L LARIA APRN (CEO)
- **Authorized official phone:** (305) 308-2513

## Contact information

- **Practice address:** 5751A SW 40TH ST, MIAMI, FL 33155-5301
- **Practice address phone:** (305) 299-7290
- **Mailing address:** 5751A SW 40TH ST, MIAMI, FL 33155-5301
- **Mailing address phone:** (305) 299-7290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/15/2020
- **Last updated:** 09/15/2020