Provider Demographics
NPI:1275397598
Name:AESTHETICA MEDICAL SPA & LASER CENTER, LLC
Entity Type:Organization
Organization Name:AESTHETICA MEDICAL SPA & LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-785-8884
Mailing Address - Street 1:385 W 600 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1330
Mailing Address - Country:US
Mailing Address - Phone:801-785-8884
Mailing Address - Fax:
Practice Address - Street 1:1865 W PLEASANT GROVE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3416
Practice Address - Country:US
Practice Address - Phone:801-785-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty