Healthcare Provider Details

I. General information

NPI: 1700750197
Provider Name (Legal Business Name): AETHERIA AESTHETICS & WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N HERITAGE DR STE 103
RIDGECREST CA
93555-5541
US

IV. Provider business mailing address

901 N HERITAGE DR STE 103
RIDGECREST CA
93555-5541
US

V. Phone/Fax

Practice location:
  • Phone: 760-282-4931
  • Fax: 760-282-4931
Mailing address:
  • Phone: 760-282-4931
  • Fax: 760-282-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SASWATHA ANIREDDY
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 760-282-4931