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General NPI Number Information
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NPI Number | 1407733496
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Entity Type | Organization
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Legal Business Name | NORTH BAY AESTHETICS INC A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 5757 WILSHIRE BLVD STE 490
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City | LOS ANGELES
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State | CA
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Zip | 90036-5811
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Country | US
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Telephone | 323-426-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 233 GRANT AVE FL 6
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4646
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Country | US
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Telephone | 415-686-3546
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JOHN HAWKINS
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Credential |
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Telephone | 415-686-3546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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