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General NPI Number Information
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NPI Number | 1184296766
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Entity Type | Organization
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Legal Business Name | COSMETIC AND AESTHETIC CLINIC LLC
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 3920 S ALMA SCHOOL RD STE 8
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City | CHANDLER
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State | AZ
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Zip | 85248-4511
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Country | US
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Telephone | 216-456-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 1392 E BARTLETT WAY
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City | CHANDLER
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State | AZ
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Zip | 85249-3132
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Country | US
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Telephone | 216-456-7741
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. KHALDOUN JABI
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Credential |
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Telephone | 216-456-7741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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