Provider Demographics
NPI:1770226185
Name:C&D MEDICAL AESTHETICS
Entity Type:Organization
Organization Name:C&D MEDICAL AESTHETICS
Other - Org Name:C&D MEDICAL AESTHETICS, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CRNA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:512-665-6911
Mailing Address - Street 1:6906 CRYSTAL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-6683
Mailing Address - Country:US
Mailing Address - Phone:512-665-6911
Mailing Address - Fax:
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3053
Practice Address - Country:US
Practice Address - Phone:254-268-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty