Provider Demographics
NPI:1235425737
Name:AESTHETIC DOCTORS GROUP INC.
Entity Type:Organization
Organization Name:AESTHETIC DOCTORS GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMAILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-482-2529
Mailing Address - Street 1:27068 LA PAZ RD # 190
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:858-759-7152
Mailing Address - Fax:310-861-0227
Practice Address - Street 1:910 BIRTCH ST #350
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-482-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30971207V00000X
CAA75774208200000X
CAA94269208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30971OtherCA STATE LICENSE
CAA75774OtherCA STATE LICENSE
CAA94269OtherCA STATE LICENSE