Healthcare Provider Details

I. General information

NPI: 1891433801
Provider Name (Legal Business Name): HOLISTIC ESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 150
PHOENIX AZ
85020-4305
US

IV. Provider business mailing address

7600 N 15TH ST STE 150
PHOENIX AZ
85020-4305
US

V. Phone/Fax

Practice location:
  • Phone: 800-831-3928
  • Fax:
Mailing address:
  • Phone: 800-831-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: TRINITI PERKINS
Title or Position: CEO
Credential:
Phone: 480-521-6698