Provider Demographics
NPI:1700407780
Name:LOLITA AESTHETICS INC
Entity Type:Organization
Organization Name:LOLITA AESTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LOLITA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-637-1770
Mailing Address - Street 1:6101 AUGUST RUN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-0543
Mailing Address - Country:US
Mailing Address - Phone:817-637-1770
Mailing Address - Fax:817-394-2415
Practice Address - Street 1:6101 AUGUST RUN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-0543
Practice Address - Country:US
Practice Address - Phone:817-637-1770
Practice Address - Fax:817-394-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center