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General NPI Number Information
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NPI Number | 1912046210
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Entity Type | Organization
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Legal Business Name | CENTER FOR AESTHETICS PC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 2375 E SUNNYSIDE ROAD SUITE G
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-529-8232
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Fax | 866-499-9979
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Provider Business Mailing Address
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Address Line | 2375 E SUNNYSIDE ROAD SUITE G
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-529-8232
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Fax | 866-499-9979
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Authorized Official
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Title or Position | OWNER
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Name | DR. CATHERINE ELIZABETH DURBORAW
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Credential | MD
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Telephone | 208-529-8232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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