Organization
KIDNEY SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN M CUELLAR M.D. (MEDICAL DIRECTOR)
(305) 329-2900
Entity
Organization
Contact information
Practice address
219 NW 12TH AVE, UNIT C4, MIAMI, FL 33128-2205
(305) 329-2900
(305) 329-2901
Mailing address
219 NW 12TH AVE, SUITE C5, MIAMI, FL 33128-2205
(305) 329-2900
(305) 329-2901
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
11/12/2007
Last updated
10/05/2012
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