Organization
AESTHETICA CLINIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS DAVID POTYONDY M.D. (MANAGING MEMBER)
(229) 589-2588
Entity
Organization
Contact information
Practice address
801 PACIFIC AVE, TACOMA, WA 98402-5209
(229) 589-2588
Mailing address
801 PACIFIC AVE, TACOMA, WA 98402-5209
(229) 589-2588
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD 60288108
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104884956
DOCTORS'S NPI
GA
05
—
569370029A
—
GA
Enumeration date
05/02/2006
Last updated
09/11/2012
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