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Organization
ETHEREAL MEDSPA LLC
Active
Organization
ETHEREAL MEDSPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISABEL M GOMEZ HERNANDEZ APRN (OWNER)
(786) 804-1241
Entity
Organization
Contact information
Practice address
13011 SW 132ND ST STE B, MIAMI, FL 33186-7197
(786) 804-1241
Mailing address
16894 SW 143RD PL, MIAMI, FL 33177-2755
(786) 804-1241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/21/2025
Last updated
03/21/2025
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