Basic Information
| Provider Information | |||||||||
| NPI: | 1972686871 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE AESTHETIC SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11181 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 1115 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341105738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395949100 | ||||||||
| FaxNumber: | 2395943054 | ||||||||
| Practice Location | |||||||||
| Address1: | 11181 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 1115 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341105738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395949100 | ||||||||
| FaxNumber: | 2395943054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MALONEY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | WEAVER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2395949100 | ||||||||
| 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 | 174400000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.