Basic Information
| Provider Information | |||||||||
| NPI: | 1821260142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARIZONA MEDICAL AESTHETIC SPECIALISTS, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARIZONA LASER AND SKIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15835 S 46TH ST | ||||||||
| Address2: | SUITE 132 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805989733 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15835 S 46TH ST | ||||||||
| Address2: | SUITE 132 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805989733 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2008 | ||||||||
| LastUpdateDate: | 03/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROBLEDO | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4805989733 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.