Healthcare Provider Details

I. General information

NPI: 1033076468
Provider Name (Legal Business Name): STANDARD OF MODERN AESTHETICS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S ARROYO PKWY FL 3
PASADENA CA
91105-2581
US

IV. Provider business mailing address

333 S ARROYO PKWY FL 3
PASADENA CA
91105-2581
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-8916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEIF ROGERS
Title or Position: SURGEON
Credential: MD
Phone: 310-860-8915