Provider Demographics
NPI:1730729229
Name:LE CLINIC FAMILY CARE AND SPA LLC
Entity type:Organization
Organization Name:LE CLINIC FAMILY CARE AND SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-798-1176
Mailing Address - Street 1:906 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4454
Mailing Address - Country:US
Mailing Address - Phone:407-593-0145
Mailing Address - Fax:407-593-0145
Practice Address - Street 1:906 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4454
Practice Address - Country:US
Practice Address - Phone:407-593-0145
Practice Address - Fax:407-593-0145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LE CLINIC FAMILY CARE AND SPA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-13
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service