MEDICARE: ART OF AESTHETICS

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	2083P0901X	Public Health & General Preventive Medicine Physician	G27287	CA

General Provider Information

NPI Number	:	1508163122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ART OF AESTHETICS

Provider Business Mailing Address
First Line	:	700 N PCH HWY
Second Line	:	300
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-374-2482
Fax Number	:	310-379-5753

Provider Business Practice Location Address
First Line	:	700 N PCH HWY
Second Line	:	300
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-374-2482
Fax Number	:	310-379-5753

Authorized Official
Title or Position	:	CEO
Name	:	MISS LJILJANAVASIC VASIC
Credential	:	RNMEP-C
Telephone Number	:	310-374-2482

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	03/11/2017

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