License Verification

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MYSTIC COSMETIC CENTER INC,

License Number: OSR1685

Data As Of 6/4/2025

Profession
Office Surgery Registration
License
OSR1685
License Status
EMERG SUSPENS/
Qualifications
Surgery w moderate/conscious to deep sedation
License Expiration Date
License Original Issue Date
06/08/2022
Address of Record
2020 SW 1ST ST
MIAMI, FL 33135
Discipline on File
No
Public Complaint
No
Alerts
Enforcement Alert
5/22/2025 5:33:59 PM
5.22.2025 - Received Order of Emergency Suspension of Registration.

No secondary locations found.


Name Relationship Profession License Effective Date
ALFONSO, IVON MARIA Anesthesia Provider Advanced Practice Registered Nurse 11015765 06/04/2024
ALONSO, CARMEN Additional Surgical Staff Unlicensed Facility Personnel 07/17/2023
ALVAREZ, FRANCISCO Anesthesia Provider Medical Doctor 46348 11/17/2022
ARGOTE GUERRERO, DELFIN Additional Surgical Staff Unlicensed Facility Personnel 07/17/2023
BROWN, STEPHANIE MARIA Anesthesia Provider Advanced Practice Registered Nurse 11007016 06/14/2023
CALDERON GAMBA, ANDRES Additional Surgical Staff Unlicensed Facility Personnel 01/15/2024
CONTRERAS GARCIA, CESAR Additional Surgical Staff Unlicensed Facility Personnel 06/16/2023
DIAZ, IAN Anesthesia Provider Advanced Practice Registered Nurse 11024169 01/15/2024
FALERO DURAN, LUIS X Anesthesia Provider Advanced Practice Registered Nurse 11012517 03/19/2024
FORTALEZA, YARIDA Officer Unlicensed Facility Personnel 06/08/2022
FORTALEZA, YARIDA Owner Unlicensed Facility Personnel 06/08/2022
FORTEZA, YARIDA Recovery Registered Nurse 9476368 06/15/2023
FRIAS SANCHEZ, ULISES Anesthesia Provider Advanced Practice Registered Nurse 11009554 08/21/2024
GARCIA-OTERO, MARIA DE LOS A Anesthesia Provider Advanced Practice Registered Nurse 2602192 06/08/2022
GOLDBERG, PAUL MICHAEL Physician Medical Doctor 93957 08/23/2024
GONZALEZ, ANDREW Anesthesia Provider Advanced Practice Registered Nurse 11023849 10/14/2024
GONZALEZ, MARIA Agent Unlicensed Facility Personnel 06/08/2022
GONZALEZ, MARIA Managing Employee Unlicensed Facility Personnel 06/08/2022
GONZALEZ, MARIA Office Manager Unlicensed Facility Personnel 06/08/2022
GONZALEZ, MARIA Officer Unlicensed Facility Personnel 06/08/2022
GONZALEZ, MARIA Owner Unlicensed Facility Personnel 06/08/2022
GONZALEZ, RENE Additional Surgical Staff Unlicensed Facility Personnel 06/08/2022
JULIAO, RACHEL Anesthesia Provider Advanced Practice Registered Nurse 11024530 12/09/2024
LAZARO, MANUEL Additional Surgical Staff Unlicensed Facility Personnel 05/07/2024
LIMAS MUSA, EDUARDO ENRIQUE Anesthesia Provider Advanced Practice Registered Nurse 11024029 01/19/2024
LORA, FERNANDO MD Physician Medical Doctor 45837 03/21/2023
MARSHALL, DEIRDRE MARGARET MD Physician Medical Doctor 64150 08/08/2024
MOLINA CUELLAR, ORESTES Additional Surgical Staff Unlicensed Facility Personnel 06/08/2022
MORALES-SANTOS, JORGE LUIS Recovery Registered Nurse 9287515 06/08/2022
MOYA CORRALES, YADIRA Additional Surgical Staff Unlicensed Facility Personnel 04/07/2024
MOYA RAIMUNDO, ADRIAN Anesthesia Provider Advanced Practice Registered Nurse 11009512 03/20/2023
MUNOZ FRANCO, RAUL Additional Surgical Staff Unlicensed Facility Personnel 08/03/2023
MUNOZ SUAREZ, WILSON Additional Surgical Staff Unlicensed Facility Personnel 04/07/2024
NOA GONZALEZ, ARMANDO Additional Surgical Staff Unlicensed Facility Personnel 07/17/2023
PELEGRIN, WENDY Recovery Registered Nurse 9499242 08/25/2023
PEREZ CASTANEDA, YASSER Additional Surgical Staff Unlicensed Facility Personnel 07/12/2023
RODRIGUEZ MEZA, ANDRES Additional Surgical Staff Unlicensed Facility Personnel 05/28/2024
RODRIGUEZ MILANES, ROBERT Additional Surgical Staff Unlicensed Facility Personnel 08/08/2024
RODRIUEZ MARTINEZ, DANIEL Additional Surgical Staff Unlicensed Facility Personnel 08/08/2024
SANTIAGO VAZQUEZ, DERECK NORBERTO Anesthesia Provider Advanced Practice Registered Nurse 11006883 09/29/2023
TORRES RUBIO, ANTONIO Additional Surgical Staff Unlicensed Facility Personnel 04/07/2024
TRIANA VILLAMIL, PEDRO Additional Surgical Staff Unlicensed Facility Personnel 06/16/2023

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 6/4/2025



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.