Healthcare Provider Details

I. General information

NPI: 1831039460
Provider Name (Legal Business Name): MEDICAL AESTHETIC ARTS LLC
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

11340 W OLYMPIC BLVD STE 255
LOS ANGELES CA
90064-1697
US

IV. Provider business mailing address

11340 W OLYMPIC BLVD STE 255
LOS ANGELES CA
90064-1697
US

V. Phone/Fax

Practice location:
  • Phone: 855-313-0481
  • Fax: 855-313-0481
Mailing address:
  • Phone: 855-313-0481
  • Fax: 855-313-0481

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 Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM REILLY
Title or Position: DIRECTOR
Credential: DR
Phone: 855-313-0481