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General NPI Number Information
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NPI Number | 1699623843
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Entity Type | Organization
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Legal Business Name | NURSE BROTOX AESTHETICS AND WELLNESS
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 1835 EL CAJON BLVD STE A
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City | SAN DIEGO
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State | CA
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Zip | 92103-2591
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Country | US
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Telephone | 858-346-8015
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Fax | 858-346-0566
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Provider Business Mailing Address
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Address Line | 302 WASHINGTON ST STE 415
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone | 858-346-8015
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Fax | 858-346-0566
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Authorized Official
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Title or Position | CEO
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Name | MR. JASON W WHALEY
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Credential | RN
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Telephone | 858-346-8015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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