Provider Demographics
NPI:1912386590
Name:VUJA DE AESTHETICS
Entity Type:Organization
Organization Name:VUJA DE AESTHETICS
Other - Org Name:LE SPA FIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAIZHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-710-3063
Mailing Address - Street 1:1700 TENNISON PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6257
Mailing Address - Country:US
Mailing Address - Phone:682-710-3063
Mailing Address - Fax:817-527-6029
Practice Address - Street 1:1700 TENNISON PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6257
Practice Address - Country:US
Practice Address - Phone:682-710-3063
Practice Address - Fax:817-527-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT115973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty