Healthcare Provider Details

I. General information

NPI: 1790968402
Provider Name (Legal Business Name): BEL-RED CENTER FOR AESTHETIC SURGERY, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 116TH AVE NE SUITE 110
BELLEVUE WA
98004-3800
US

IV. Provider business mailing address

1260 116TH AVE NE SUITE 110
BELLEVUE WA
98004-3809
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-7225
  • Fax: 425-455-0045
Mailing address:
  • Phone: 425-455-7225
  • Fax: 425-455-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD00024917
License Number StateWA

VIII. Authorized Official

Name: EVA ZEMPLENYI
Title or Position: VICE PRESIDENT
Credential:
Phone: 425-455-7225