| Live Medspa | |
|
8205 Nw 12th St Unit 4 Doral FL 33126-1837 | |
| (305) 699-9791 | |
| (786) 946-1156 |
| Full Name | Live Medspa |
|---|---|
| Speciality | General Practice |
| Location | 8205 Nw 12th St Unit 4, Doral, Florida |
| Authorized Official Name and Position | Andres Rodriguez (CEO / PRESIDENT) |
| Authorized Official Contact | 3056999791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Medspa 8205 Nw 12th St Unit 4 Doral FL 33126-1837 Ph: (305) 699-9791 | Live Medspa 8205 Nw 12th St Unit 4 Doral FL 33126-1837 Ph: (305) 699-9791 |
| NPI Number | 1205400959 |
|---|---|
| Provider Enumeration Date | 05/18/2021 |
| Last Update Date | 02/25/2022 |
| Medicare PECOS PAC ID | 7315331352 |
|---|---|
| Medicare Enrollment ID | O20220308001749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205400959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Martin Gomez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1134671290 PECOS PAC ID: 1052419744 Enrollment ID: I20190226000363 |
| Provider Name | Yul Marietta Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467938282 PECOS PAC ID: 3375886609 Enrollment ID: I20190529002946 |
| Provider Name | Danay Mercedes Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124591235 PECOS PAC ID: 2860656725 Enrollment ID: I20220324001934 |
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