MEDICARE: JULIE MARIE AESTHETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1104768639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE MARIE AESTHETICS LLC

Provider Business Mailing Address
First Line	:	4521 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2603
Country	:	US
Telephone Number	:	361-299-5317
Fax Number	:	361-431-1103

Provider Business Practice Location Address
First Line	:	4521 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2603
Country	:	US
Telephone Number	:	361-299-5317
Fax Number	:	361-431-1103

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE VASQUEZ
Credential	:
Telephone Number	:	210-862-8849

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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