# AEVA CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aeva Ageless Aesthetics Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750886784
- **Authorized official:** BARBARA DEINET (PRESIDENT)
- **Authorized official phone:** (702) 219-6173

## Contact information

- **Practice address:** 4641 BLUE DIAMOND RD STE 120A, LAS VEGAS, NV 89139-7610
- **Practice address phone:** (702) 558-2382
- **Practice address fax:** (702) 558-5407
- **Mailing address:** 6280 S VALLEY VIEW BLVD STE 734, LAS VEGAS, NV 89118-6833
- **Mailing address phone:** (702) 558-2382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/30/2018
- **Last updated:** 09/18/2018