Provider Demographics
NPI:1477384881
Name:AESTHETICS VERDUZCO PLLC
Entity type:Organization
Organization Name:AESTHETICS VERDUZCO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDUZCO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:509-901-7991
Mailing Address - Street 1:1021 S 40TH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3878
Mailing Address - Country:US
Mailing Address - Phone:509-490-5665
Mailing Address - Fax:
Practice Address - Street 1:1021 S 40TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3878
Practice Address - Country:US
Practice Address - Phone:509-490-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center