Provider Demographics
NPI:1134654866
Name:QUIAMZON AESTHETIC AND CONCIERGE HEALTHCARE
Entity Type:Organization
Organization Name:QUIAMZON AESTHETIC AND CONCIERGE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIAMZON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:702-499-0589
Mailing Address - Street 1:10885 S EASTERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5857
Mailing Address - Country:US
Mailing Address - Phone:702-499-0589
Mailing Address - Fax:702-442-9898
Practice Address - Street 1:10885 S EASTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5857
Practice Address - Country:US
Practice Address - Phone:702-499-0589
Practice Address - Fax:702-442-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty