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Organization
MED THERAPEUTIC SKIN CARE DAY SPA
Active
Organization
MED THERAPEUTIC SKIN CARE DAY SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIDIA MOSQUERA LPG (OWNER)
(770) 849-0206
Entity
Organization
Contact information
Practice address
5344 JIMMY CARTER BLVD, 1 C, NORCROSS, GA 30093-1516
(770) 849-0206
(770) 849-0206
Mailing address
5344 JIMMY CARTER BLVD, 1 C, NORCROSS, GA 30093-1516
(770) 849-0206
(770) 849-0206
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
2013005065
GA
302F00000X
Exclusive Provider Organization
Primary
2013005065
GA
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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