Provider Demographics
NPI:1376725887
Name:RONDEROS AESTHETICS, LLC
Entity Type:Organization
Organization Name:RONDEROS AESTHETICS, LLC
Other - Org Name:SKIN PERFECTION MED SPA
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:RONDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-776-1380
Mailing Address - Street 1:1132 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3920
Mailing Address - Country:US
Mailing Address - Phone:251-776-1380
Mailing Address - Fax:251-776-1381
Practice Address - Street 1:1132 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3920
Practice Address - Country:US
Practice Address - Phone:251-776-1380
Practice Address - Fax:251-776-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20619207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51544969OtherBLUE CROSS BLUE SHIELD AL