Provider Demographics
NPI:1043523798
Name:RETREAT EUROPEAN ESTHETICS PL
Entity type:Organization
Organization Name:RETREAT EUROPEAN ESTHETICS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:MANUELA
Authorized Official - Last Name:STOICI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-498-6554
Mailing Address - Street 1:2837 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8603
Mailing Address - Country:US
Mailing Address - Phone:727-498-6554
Mailing Address - Fax:727-498-6555
Practice Address - Street 1:2837 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8603
Practice Address - Country:US
Practice Address - Phone:727-498-6554
Practice Address - Fax:727-498-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL240400Medicaid