Provider Demographics
NPI:1821842642
Name:DESERT ROSE INK & AESTHETICS LLC
Entity Type:Organization
Organization Name:DESERT ROSE INK & AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARAMEDICAL TATTOO ARTIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LEIGH-STEED
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-671-0904
Mailing Address - Street 1:17180 W SWEETWATER AVE UNIT 1088
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3404
Mailing Address - Country:US
Mailing Address - Phone:928-671-0904
Mailing Address - Fax:
Practice Address - Street 1:117 N FRONTIER ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1418
Practice Address - Country:US
Practice Address - Phone:928-671-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty