Ageless Aesthetic Center, LLC

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

Legal business name

AGELESS AESTHETIC CENTER, LLC

Practice address

2665 Executive Park Dr
Suite 1
Weston, FL 33331-3652

Phone

(954) 454-4900

NPI assigned

Dec 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alfonso Riviezzo

Title

Billing Manager

Phone

(719) 955-9128

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230508800000",
    "number": "1124264973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2665 EXECUTIVE PARK DR",
            "address_2": "SUITE 1",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313652",
            "telephone_number": "954-454-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2665 EXECUTIVE PARK DR",
            "address_2": "SUITE 1",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313652",
            "telephone_number": "954-454-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS AESTHETIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-29",
        "last_updated": "2008-12-29",
        "status": "A",
        "authorized_official_last_name": "RIVIEZZO",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "719-955-9128"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Phlebology Physician in Weston, FL
• Providers in Weston, FL by specialty
• Phlebology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.