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General NPI Number Information
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NPI Number | 1972240026
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Entity Type | Organization
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Legal Business Name | MEDICAL AND AESTHETIC CENTER, INC.
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 2641 W HORIZON RIDGE PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89052-4836
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Country | US
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Telephone | 702-998-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 BELGREEN ST
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City | LAS VEGAS
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State | NV
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Zip | 89135-1761
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Country | US
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Telephone | 702-998-1399
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HUGH BURT
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Credential | M.D.
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Telephone | 702-296-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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