MEDICARE: MEDICAL AESTHETICS & REJUVENATION PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101200000X	Drama Therapist
2	111N00000X	Chiropractor
3	163W00000X	Registered Nurse
4	208200000X	Plastic Surgery Physician
5	225XM0800X	Mental Health Occupational Therapist
6	364S00000X	Clinical Nurse Specialist
7	364SA2200X	Adult Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1659211282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL AESTHETICS & REJUVENATION PA

Provider Business Mailing Address
First Line	:	6565 W SUNSET BLVD STE 211
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7206
Country	:	US
Telephone Number	:	866-316-7809
Fax Number	:	866-316-7809

Provider Business Practice Location Address
First Line	:	6565 W SUNSET BLVD STE 211
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7206
Country	:	US
Telephone Number	:	866-316-7809
Fax Number	:	866-316-7809

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ALBERT DEC
Credential	:	DR
Telephone Number	:	866-316-7809

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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