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General NPI Number Information
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NPI Number | 1922814839
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Entity Type | Organization
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Legal Business Name | I.B. MEDICAL AESTHETIQUES & WELLNESS PC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1555 PALM AVE STE J2
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City | SAN DIEGO
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State | CA
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Zip | 92154-1012
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Country | US
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Telephone | 619-490-3112
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 PALM AVE STE J2
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City | SAN DIEGO
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State | CA
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Zip | 92154-1012
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Country | US
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Telephone | 619-490-3112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMELIA M. BUENVENIDA
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Credential | DNP
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Telephone | 619-201-3858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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