Provider Demographics
NPI:1184296766
Name:COSMETIC AND AESTHETIC CLINIC LLC
Entity type:Organization
Organization Name:COSMETIC AND AESTHETIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALDOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-456-7741
Mailing Address - Street 1:1392 E BARTLETT WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3132
Mailing Address - Country:US
Mailing Address - Phone:216-456-7741
Mailing Address - Fax:
Practice Address - Street 1:3920 S ALMA SCHOOL RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4511
Practice Address - Country:US
Practice Address - Phone:216-456-7741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty