Provider Demographics
NPI:1508272337
Name:THE CALIFORNIA INSTITUTE FOR AESTHETIC MEDICINE
Entity Type:Organization
Organization Name:THE CALIFORNIA INSTITUTE FOR AESTHETIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:P.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RICKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-678-0220
Mailing Address - Street 1:8875 COSTA VERDE BLVD
Mailing Address - Street 2:APT 407
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-6656
Mailing Address - Country:US
Mailing Address - Phone:858-678-0220
Mailing Address - Fax:
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:SUITE 360
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9124
Practice Address - Country:US
Practice Address - Phone:858-678-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37788207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty