Provider Demographics
NPI:1184375156
Name:LUXE AESTHETICS PLLC
Entity type:Organization
Organization Name:LUXE AESTHETICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-443-2557
Mailing Address - Street 1:3731 NW CARY PARKWAY
Mailing Address - Street 2:PO BOX 1027
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560
Mailing Address - Country:US
Mailing Address - Phone:919-443-2557
Mailing Address - Fax:919-869-1869
Practice Address - Street 1:3731 NW CARY PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8436
Practice Address - Country:US
Practice Address - Phone:919-443-2557
Practice Address - Fax:919-869-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty