Provider Demographics
NPI:1316090590
Name:TRIANA INSTITUTE FOR AESTHETIC SURGERY & AGE MANAGEMENT PA
Entity type:Organization
Organization Name:TRIANA INSTITUTE FOR AESTHETIC SURGERY & AGE MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:JOSPEH
Authorized Official - Last Name:TRIANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-202-9102
Mailing Address - Street 1:211 S OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3312
Mailing Address - Country:US
Mailing Address - Phone:561-202-9102
Mailing Address - Fax:561-585-5514
Practice Address - Street 1:211 S OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3312
Practice Address - Country:US
Practice Address - Phone:561-202-9102
Practice Address - Fax:561-585-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty