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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