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General NPI Number Information
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NPI Number | 1952112138
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Entity Type | Organization
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Legal Business Name | PURE AESTHETICS & WELLNESS
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 9033 BASE LINE RD STE N
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1215
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Country | US
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Telephone | 909-997-8618
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Fax |
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Provider Business Mailing Address
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Address Line | 9033 BASE LINE RD STE N
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1215
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Country | US
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Telephone | 909-997-8618
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIZA MEZA
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Credential | NP
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Telephone | 909-997-8618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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