Provider Demographics
NPI:1578508057
Name:ADVANCED AESTHETIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ADVANCED AESTHETIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:PRICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-331-7811
Mailing Address - Street 1:PO BOX 207435
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7433
Mailing Address - Country:US
Mailing Address - Phone:480-625-0003
Mailing Address - Fax:480-842-8760
Practice Address - Street 1:8900 E RAINTREE DR STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7307
Practice Address - Country:US
Practice Address - Phone:480-752-7874
Practice Address - Fax:480-842-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34430208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ34430OtherMEDICAL LICENSE
AZ966228Medicaid
AZI43146Medicare UPIN
AZ966228Medicaid