1184180739 NPI number — LUMIERE COSMETIC VEIN CENTER P A

Table of content: (NPI 1184180739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184180739 NPI number — LUMIERE COSMETIC VEIN CENTER P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUMIERE COSMETIC VEIN CENTER P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUMIERE COSMETIC VEIN CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184180739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2546 HEYDON LN STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33991-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-317-0333
Provider Business Mailing Address Fax Number:
855-574-2200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2546 HEYDON LN STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33991-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-732-6728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CIPRIANO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-317-0333

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com