Provider Demographics
NPI:1669177192
Name:ELITE AESTHETICS & DERMATOLOGY INC
Entity type:Organization
Organization Name:ELITE AESTHETICS & DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUGAS-GENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:413-519-5594
Mailing Address - Street 1:3409 CALLOWAY DR UNIT 602
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3409 CALLOWAY DR UNIT 602
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2534
Practice Address - Country:US
Practice Address - Phone:661-218-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427432293Medicaid
CA1952992539Medicaid
CA1003549544Medicaid