Provider Demographics
NPI:1780428094
Name:ONALASKA WELLNESS AND AESTHETICS WORKS LLC
Entity type:Organization
Organization Name:ONALASKA WELLNESS AND AESTHETICS WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PALOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:936-223-2156
Mailing Address - Street 1:14290 US HIGHWAY 190 W STE B
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:TX
Mailing Address - Zip Code:77360-7992
Mailing Address - Country:US
Mailing Address - Phone:936-646-6058
Mailing Address - Fax:
Practice Address - Street 1:14290 US HIGHWAY 190 W STE B
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:TX
Practice Address - Zip Code:77360-7992
Practice Address - Country:US
Practice Address - Phone:936-646-6058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center