Healthcare Provider Details

I. General information

NPI: 1467357566
Provider Name (Legal Business Name): LUXE MEDICAL AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33492 OAK GLEN RD STE I
YUCAIPA CA
92399-2096
US

IV. Provider business mailing address

33492 OAK GLEN RD STE I
YUCAIPA CA
92399-2096
US

V. Phone/Fax

Practice location:
  • Phone: 909-801-0486
  • Fax:
Mailing address:
  • Phone: 909-801-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN DESANTIS
Title or Position: CEO
Credential: DO
Phone: 909-801-0486