Healthcare Provider Details

I. General information

NPI: 1255225298
Provider Name (Legal Business Name): AESTHETIC EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 NW 122ND ST UNIT 19
HIALEAH GARDENS FL
33018-2083
US

IV. Provider business mailing address

19831 SW 84TH AVE
CUTLER BAY FL
33189-2017
US

V. Phone/Fax

Practice location:
  • Phone: 786-416-4405
  • Fax:
Mailing address:
  • Phone: 786-416-4405
  • 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: ZAIRA MONTERO RIVERA
Title or Position: OWNER/NURSE PRACTITIONER
Credential: AG-ACNP/FNP/APRN
Phone: 786-416-4405