Provider Demographics
NPI:1033459987
Name:GLOSS SALON & SPA
Entity type:Organization
Organization Name:GLOSS SALON & SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:772-567-5555
Mailing Address - Street 1:306 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1431
Mailing Address - Country:US
Mailing Address - Phone:772-567-5555
Mailing Address - Fax:
Practice Address - Street 1:1255 37TH ST
Practice Address - Street 2:SUITE
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-562-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53688171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty