Organization
BRICK CITY AESTHETICS LLC
Active
Other names
Brick City Aesthetics LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DARIO BYUNG SAN ROMAN NP (MEDICAL DIRECTOR/CO-OWNER)
(719) 289-1139
Entity
Organization
Contact information
Practice address
328 S BONAVENTURE AVE STE 2, TRINIDAD, CO 81082-2086
(719) 680-3509
Mailing address
215 CORUNDUM RD, TRINIDAD, CO 81082-9413
(719) 680-3509
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/10/2023
Last updated
02/10/2023
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