Organization
REJUVENATE MED SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALTAGRACIA MIRANDA (PRESIDENT/MD)
(954) 925-8100
Entity
Organization
Contact information
Practice address
1111 BRICKELL AVE FL 11, MIAMI, FL 33131-3122
(954) 925-8100
(954) 827-3913
Mailing address
1111 BRICKELL AVE FL 11, MIAMI, FL 33131-3122
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME87277
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267920500
—
FL
Enumeration date
12/13/2010
Last updated
12/13/2010
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