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General NPI Number Information
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NPI Number | 1275397598
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Entity Type | Organization
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Legal Business Name | AESTHETICA MEDICAL SPA & LASER CENTER, LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 1865 W PLEASANT GROVE BLVD STE A
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3416
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Country | US
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Telephone | 801-785-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 385 W 600 N
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City | LINDON
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State | UT
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Zip | 84042-1330
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Country | US
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Telephone | 801-785-8884
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CHRISTOPHER CROFTS
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Credential |
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Telephone | 801-785-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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