Healthcare Provider Details

I. General information

NPI: 1013838911
Provider Name (Legal Business Name): PRESTIGIOUS MEDICAL AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40820 WINCHESTER RD STE 2505
TEMECULA CA
92591-5525
US

IV. Provider business mailing address

40820 WINCHESTER RD STE 2505
TEMECULA CA
92591-5525
US

V. Phone/Fax

Practice location:
  • Phone: 951-764-5962
  • Fax:
Mailing address:
  • Phone: 951-764-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SELEAINA A THOMAS
Title or Position: OWNER
Credential: DNP FNP
Phone: 951-764-5962