Provider Demographics
NPI:1619704202
Name:EPITOME OF YOUTH WELLNESS & AESTHETICS LLC
Entity type:Organization
Organization Name:EPITOME OF YOUTH WELLNESS & AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:702-280-2458
Mailing Address - Street 1:605 E CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-9388
Mailing Address - Country:US
Mailing Address - Phone:702-280-2458
Mailing Address - Fax:
Practice Address - Street 1:213 S CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5734
Practice Address - Country:US
Practice Address - Phone:575-725-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty