Healthcare Provider Details

I. General information

NPI: 1588241236
Provider Name (Legal Business Name): BELEZA AESTHETIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4618 LYNNCREST DR
HAMPSTEAD MD
21074-2610
US

IV. Provider business mailing address

4618 LYNNCREST DR
HAMPSTEAD MD
21074-2610
US

V. Phone/Fax

Practice location:
  • Phone: 443-804-2788
  • Fax:
Mailing address:
  • Phone: 443-804-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BECCIO
Title or Position: CRNP
Credential: CRNP
Phone: 410-878-7754