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General NPI Number Information
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NPI Number | 1861000317
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Entity Type | Organization
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Legal Business Name | BELLA AESTHETICA, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 625 N EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3223
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Country | US
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Telephone | 909-984-7500
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Fax | 909-984-7550
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Provider Business Mailing Address
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Address Line | 625 N EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3223
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Country | US
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Telephone | 909-984-7500
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Fax | 909-984-7550
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MS. LINDA KOKLAS
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Credential |
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Telephone | 323-712-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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