Provider Demographics
NPI:1134713522
Name:PEARLLA MEDICAL AESTHETICS
Entity type:Organization
Organization Name:PEARLLA MEDICAL AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-929-9344
Mailing Address - Street 1:825 TAMARACK AVE APT 76
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2532
Mailing Address - Country:US
Mailing Address - Phone:310-929-9344
Mailing Address - Fax:
Practice Address - Street 1:9350 WILSHIRE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3204
Practice Address - Country:US
Practice Address - Phone:310-929-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier