Organization
LAVERNIA MEDI-SPA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PEDRO L PUEBLA (PRESIDENT)
(305) 629-9662
Entity
Organization
Contact information
Practice address
7902 N.W. 36 STREET, SUITE 201, MIAMI, FL 33166
(305) 629-9662
(305) 629-9663
Mailing address
7902 N.W. 36 STREET, 201, DORAL, FL 33166
(305) 629-9662
(305) 629-9663
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC5400
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC5400
AHCA LICENSE
FL
Enumeration date
11/06/2006
Last updated
08/22/2020
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