Provider Demographics
NPI:1255127528
Name:AESTHETIC BEAUTY LAB LLC
Entity type:Organization
Organization Name:AESTHETIC BEAUTY LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONIDA NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-749-1703
Mailing Address - Street 1:15875 EMPEROR AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7803
Mailing Address - Country:US
Mailing Address - Phone:612-749-1703
Mailing Address - Fax:
Practice Address - Street 1:15875 EMPEROR AVE STE 120
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7803
Practice Address - Country:US
Practice Address - Phone:612-749-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center