Provider Demographics
NPI:1003417643
Name:NEW SKIN AND BODY AESTHETICS INC
Entity type:Organization
Organization Name:NEW SKIN AND BODY AESTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRHOSENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-485-2100
Mailing Address - Street 1:4980 BARRANCA PARKWAY
Mailing Address - Street 2:201
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-485-2100
Mailing Address - Fax:
Practice Address - Street 1:4980 BARRANCA PARKWAY
Practice Address - Street 2:201
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-485-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty