Provider Demographics
NPI:1619654506
Name:HOLISTIC AESTHETIC WELLNESS INC
Entity Type:Organization
Organization Name:HOLISTIC AESTHETIC WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREJON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-351-6114
Mailing Address - Street 1:PO BOX 174012
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33017-4012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9240 SW 72ND ST STE 241
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3265
Practice Address - Country:US
Practice Address - Phone:305-271-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty