MEDICARE: AESTHETICS AND HEALTH, 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	261QH0100X	Health Service Clinic/Center	ME112185	FL

General Provider Information

NPI Number	:	1841614898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETICS AND HEALTH, INC.

Provider Business Mailing Address
First Line	:	4015 INDIAN CREEK DR APT 302
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3747
Country	:	US
Telephone Number	:	305-763-0072
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 INDIAN CREEK DR APT 302
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3747
Country	:	US
Telephone Number	:	305-763-0072
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILSON IZQUIERDO
Credential	:
Telephone Number	:	305-763-0072

Provider Enumeration Date	:	02/11/2014
Last Update Date	:	03/11/2014

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