Provider Demographics
NPI:1225734569
Name:1ST CLAS AESTHETICS & HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:1ST CLAS AESTHETICS & HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIBIO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:405-881-9773
Mailing Address - Street 1:1369 TRALEE CIR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2643
Mailing Address - Country:US
Mailing Address - Phone:405-881-9773
Mailing Address - Fax:
Practice Address - Street 1:1020 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1606
Practice Address - Country:US
Practice Address - Phone:443-409-6619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN99885Medicaid