Healthcare Provider Details

I. General information

NPI: 1851203020
Provider Name (Legal Business Name): HEALINQUE AESTHETIC AND LONGEVITY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15644 POMERADO RD STE 104
POWAY CA
92064-2419
US

IV. Provider business mailing address

15644 POMERADO RD STE 104
POWAY CA
92064-2419
US

V. Phone/Fax

Practice location:
  • Phone: 858-633-5991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AZADEH SHIRAZI
Title or Position: OWNER
Credential: MD
Phone: 858-633-5991