Provider Demographics
NPI:1013298751
Name:AETHETIC ARTS INSTITUTE OF PLASTIC SURGERY,LLC
Entity type:Organization
Organization Name:AETHETIC ARTS INSTITUTE OF PLASTIC SURGERY,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-464-9876
Mailing Address - Street 1:8401 GRANT AVE.
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-464-9876
Mailing Address - Fax:619-464-9877
Practice Address - Street 1:8401 GRANT AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5303
Practice Address - Country:US
Practice Address - Phone:619-464-9876
Practice Address - Fax:619-464-9877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AETHETIC ARTS INSTITUTE OF PLASTICV SURGERY,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-08
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05C0001125332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment