1790968402 NPI number — BEL-RED CENTER FOR AESTHETIC SURGERY, P.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790968402 NPI number — BEL-RED CENTER FOR AESTHETIC SURGERY, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEL-RED CENTER FOR AESTHETIC SURGERY, P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790968402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 116TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-3809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-455-7225
Provider Business Mailing Address Fax Number:
425-455-0045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 116TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-455-7225
Provider Business Practice Location Address Fax Number:
425-455-0045
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZEMPLENYI
Authorized Official First Name:
EVA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
425-455-7225

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  MD00024917 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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