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General NPI Number Information
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NPI Number | 1477175792
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Entity Type | Organization
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Legal Business Name | WELLNESS AESTHETICS CENTRAL COAST
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 4450 CAPITOLA RD STE 105
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City | CAPITOLA
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State | CA
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Zip | 95010-3570
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Country | US
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Telephone | 831-325-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 CAPITOLA RD STE 105
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City | CAPITOLA
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State | CA
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Zip | 95010-3570
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Country | US
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Telephone | 831-325-0202
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JENNIFER STANLEY
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Credential | MD
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Telephone | 831-325-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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