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Organization
ETHEREAL MEDSPA LLC
Active
Organization
ETHEREAL MEDSPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISABEL MARIA GOMEZ HERNANDEZ APRN (APRN)
(786) 804-1241
Entity
Organization
Contact information
Practice address
13011 SW 132ND ST, MIAMI, FL 33186-7197
(786) 804-1241
Mailing address
13011 SW 132ND ST, MIAMI, FL 33186-7197
(786) 804-1241
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/02/2026
Last updated
07/14/2026
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