Provider Demographics
NPI:1992171037
Name:RADIANCE HEALTH AND BEAUTY
Entity type:Organization
Organization Name:RADIANCE HEALTH AND BEAUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FULL SPECIALIST/LMT
Authorized Official - Prefix:
Authorized Official - First Name:ROCIO
Authorized Official - Middle Name:I
Authorized Official - Last Name:LORA
Authorized Official - Suffix:
Authorized Official - Credentials:FS/LMT
Authorized Official - Phone:407-758-7874
Mailing Address - Street 1:936 S LAKE STERLING CT
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5400
Mailing Address - Country:US
Mailing Address - Phone:407-758-7874
Mailing Address - Fax:
Practice Address - Street 1:1850 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4559
Practice Address - Country:US
Practice Address - Phone:407-758-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFS878771174400000X
FLMA60398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty