1104473248 NPI number — APLO HEALTH AND AESTHETICS LLC

Table of content: BRIAN L STAUFFER MD (NPI 1912017757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104473248 NPI number — APLO HEALTH AND AESTHETICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APLO HEALTH AND AESTHETICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ICARE MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104473248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10881 WOODS HOLE BAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89179-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2831 BUSINESS PARK CT STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-713-5347
Provider Business Practice Location Address Fax Number:
844-858-9345
Provider Enumeration Date:
08/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
AGUILUZ-DIZON
Authorized Official First Name:
JENESA
Authorized Official Middle Name:
Authorized Official Title or Position:
APRN
Authorized Official Telephone Number:
509-713-4619

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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