Healthcare Provider Details

I. General information

NPI: 1649568023
Provider Name (Legal Business Name): AESTHETIQUE LASER INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 603
BEVERLY HILLS CA
90211-1970
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE 603
BEVERLY HILLS CA
90211-1970
US

V. Phone/Fax

Practice location:
  • Phone: 310-734-7333
  • Fax:
Mailing address:
  • Phone: 310-734-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA39618
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHARON MCBETH
Title or Position: CEO
Credential: M.D.
Phone: 949-646-7336