MEDICARE: ADVANCED AESTHETICS AND REJUVINATION INC

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	2086S0122X	Plastic and Reconstructive Surgery Physician	1402156	OH

General Provider Information

NPI Number	:	1114248044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED AESTHETICS AND REJUVINATION INC

Provider Business Mailing Address
First Line	:	5661 LAKE SHORE AVE
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8174
Country	:	US
Telephone Number	:	440-274-5000
Fax Number	:	440-716-8608

Provider Business Practice Location Address
First Line	:	30701 LORAIN RD STE A
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-6325
Country	:	US
Telephone Number	:	440-274-5000
Fax Number	:	440-716-8608

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID A GARCIA
Credential	:	DO
Telephone Number	:	440-274-5000

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	06/15/2010

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