Provider Demographics
NPI:1821260142
Name:ARIZONA MEDICAL AESTHETIC SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:ARIZONA MEDICAL AESTHETIC SPECIALISTS, PLLC
Other - Org Name:ARIZONA LASER AND SKIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-598-9733
Mailing Address - Street 1:15835 S 46TH ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0446
Mailing Address - Country:US
Mailing Address - Phone:480-598-9733
Mailing Address - Fax:
Practice Address - Street 1:15835 S 46TH ST
Practice Address - Street 2:SUITE 132
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0446
Practice Address - Country:US
Practice Address - Phone:480-598-9733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty