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General NPI Number Information
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NPI Number | 1619821279
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Entity Type | Organization
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Legal Business Name | SOULFUL MED SPA, LLC DBA AWAKEN AESTHETICS
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 3050 ELM RD NE STE 2
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City | WARREN
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State | OH
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Zip | 44483-2620
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Country | US
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Telephone | 330-469-5059
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 ELM RD NE STE 2
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City | WARREN
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State | OH
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Zip | 44483-2620
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Country | US
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Telephone | 330-469-5059
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHETNA PATEL
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Credential | APRN
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Telephone | 330-224-5082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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