| Organization Name: | AETHETIC ARTS INSTITUTE OF PLASTIC SURGERY,LLC |
| NPI Number: | 1013298751 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN KAWESKI (MEDICAL DIRECTOR) |
| Mailing Address: | 8401 Grant Ave La Mesa |
| State: | CA US |
| Postal Code: | 919415303 |
| Phone Number: | 6194649876 |
| Fax Number: | 6194649877 |
| NPI Enumeration Date: | 09/08/2011 |
| NPI Last Update Date: | 02/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 05C0001125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |