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Organization

CARIBBEAN BLUE SPA CORP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ILIANA MASTRAPA ARNP (PROVIDER)
(786) 899-0923
Entity
Organization

Contact information

Practice address
285 NW 27TH AVE, MIAMI, FL 33125-5131
(786) 899-0923
Mailing address
285 NW 27TH AVE STE 17, MIAMI, FL 33125-5133

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
HCC11225
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1538605266
FL
Enumeration date
09/21/2017
Last updated
12/08/2017
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