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General NPI Number Information
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NPI Number | 1770009243
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Entity Type | Organization
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Legal Business Name | BELLEZZA LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 7500 E PINNACLE PEAK RD STE A-207
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3406
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Country | US
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Telephone | 480-419-6996
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Fax | 480-419-6134
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Provider Business Mailing Address
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Address Line | 39122 N 26TH ST
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City | CAVE CREEK
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State | AZ
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Zip | 85331-0797
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC DAVID MAASS
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Credential |
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Telephone | 602-501-5087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP4134
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | AP4134
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License Number State | AZ
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