Healthcare Provider Details

I. General information

NPI: 1659211282
Provider Name (Legal Business Name): MEDICAL AESTHETICS & REJUVENATION PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W SUNSET BLVD STE 211
LOS ANGELES CA
90028-7206
US

IV. Provider business mailing address

6565 W SUNSET BLVD STE 211
LOS ANGELES CA
90028-7206
US

V. Phone/Fax

Practice location:
  • Phone: 866-316-7809
  • Fax: 866-316-7809
Mailing address:
  • Phone: 866-316-7809
  • Fax: 866-316-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT DEC
Title or Position: DIRECTOR
Credential: DR
Phone: 866-316-7809