Organization Name: | GENX MEDICAL SPA |
NPI Number: | 1780076729 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDREA CARRASCO (PRESIDENT) |
Mailing Address: | 823 S University Dr # C-94 Plantation |
State: | FL US |
Postal Code: | 333243317 |
Phone Number: | 9549936847 |
Fax Number: | |
NPI Enumeration Date: | 02/27/2015 |
NPI Last Update Date: | 02/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |