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General NPI Number Information
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NPI Number | 1124273685
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Entity Type | Organization
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Legal Business Name | AESTHETIC ARTISTRY SURGICAL AND MEDICAL CENTER LLC
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1841 IRON POINT RD
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City | FOLSOM
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State | CA
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Zip | 95630-8838
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Country | US
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Telephone | 916-983-9895
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Fax | 916-983-9850
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Provider Business Mailing Address
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Address Line | 2220 E BIDWELL ST
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City | FOLSOM
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State | CA
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Zip | 95630-3546
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Country | US
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Telephone | 916-983-9895
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | LISA BOWMAN
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Credential |
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Telephone | 208-559-7417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A63302
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License Number State | CA
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