MEDICARE: AESTHETICA PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133NN1002X	Nutrition Education Nutritionist
2	224Y00000X	Clinical Exercise Physiologist
3	261QM1300X	Multi-Specialty Clinic/Center
4	261QP2000X	Physical Therapy Clinic/Center
5	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1174343883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETICA PLLC

Provider Business Mailing Address
First Line	:	45 E MONTEREY WAY STE 202
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2757
Country	:	US
Telephone Number	:	602-791-0199
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 E MONTEREY WAY STE 202
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2757
Country	:	US
Telephone Number	:	602-791-0199
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. TIFFANY HARRIS
Credential	:	PHD, CMOT, CSCS
Telephone Number	:	602-791-0199

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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Directions to “AESTHETICA PLLC ” Practice Location

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