| Organization Name: | TAHOE AESTHETIC AND INTEGRATIVE MEDICINE, LLC |
| NPI Number: | 1023321718 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REBECCA GELBER (MANAGING MEMBER) |
| Mailing Address: | 770 Northwood Blvd Incline Village |
| State: | NV US |
| Postal Code: | 894518284 |
| Phone Number: | 7752981750 |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2010 |
| NPI Last Update Date: | 07/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 10275 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |