1134654866 NPI number — QUIAMZON AESTHETIC AND CONCIERGE HEALTHCARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134654866 NPI number — QUIAMZON AESTHETIC AND CONCIERGE HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUIAMZON AESTHETIC AND CONCIERGE HEALTHCARE
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:
Provider Other Organization Name Type Code:
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:
1134654866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10885 S EASTERN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-5857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-499-0589
Provider Business Mailing Address Fax Number:
702-442-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10885 S EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-5857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-499-0589
Provider Business Practice Location Address Fax Number:
702-442-9898
Provider Enumeration Date:
05/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
QUIAMZON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/NURSE PRACTITIONER
Authorized Official Telephone Number:
702-499-0589

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com