Organization
BELLA AESTHETICA, A PROFESSIONAL CORPORATION
Active
Other names
Bella Aesthetica MedSpa & Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA KOKLAS (CHIEF OPERATING OFFICER)
(323) 712-4811
Entity
Organization
Contact information
Practice address
625 N EUCLID AVE, ONTARIO, CA 91762-3223
(909) 984-7500
(909) 984-7550
Mailing address
625 N EUCLID AVE, ONTARIO, CA 91762-3223
(909) 984-7500
(909) 984-7550
Taxonomy
Speciality
Code
Description
License number
State
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB315364
MEDICARE
CA
Enumeration date
07/21/2020
Last updated
07/21/2020
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