Healthcare Provider Details

I. General information

NPI: 1134713522
Provider Name (Legal Business Name): PEARLLA MEDICAL AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 WILSHIRE BLVD STE 203
BEVERLY HILLS CA
90212-3204
US

IV. Provider business mailing address

825 TAMARACK AVE APT 76
BREA CA
92821-2532
US

V. Phone/Fax

Practice location:
  • Phone: 310-929-9344
  • Fax:
Mailing address:
  • Phone: 310-929-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: AVIA NICHOLSON
Title or Position: OWNER
Credential:
Phone: 310-929-9344