Provider Demographics
NPI:1982586970
Name:SOUNTHWEST MEDSPA LLC
Entity type:Organization
Organization Name:SOUNTHWEST MEDSPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIFE
Authorized Official - Middle Name:STARKEY
Authorized Official - Last Name:ABISTADO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:630-449-4794
Mailing Address - Street 1:9234 HARLOWE LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1057
Mailing Address - Country:US
Mailing Address - Phone:630-449-4794
Mailing Address - Fax:630-566-4869
Practice Address - Street 1:1606 W COLONIAL PKWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4738
Practice Address - Country:US
Practice Address - Phone:630-449-4794
Practice Address - Fax:630-566-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty