MEDICARE: BELLA AESTHETICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1144889627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA AESTHETICS PLLC

Provider Business Mailing Address
First Line	:	5140 CATHEDRAL LN
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-1490
Country	:	US
Telephone Number	:	617-784-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LOOP 11
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76306-3705
Country	:	US
Telephone Number	:	940-723-8420
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. CRISTINA BEATRICE
Credential	:	MD
Telephone Number	:	617-784-0009

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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