Healthcare Provider Details

I. General information

NPI: 1518887231
Provider Name (Legal Business Name): GLOW DISTRICT MEDSPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 W MAGNOLIA BLVD STE 101
BURBANK CA
91506-1840
US

IV. Provider business mailing address

1714 W MAGNOLIA BLVD STE 101
BURBANK CA
91506-1840
US

V. Phone/Fax

Practice location:
  • Phone: 747-324-7797
  • Fax:
Mailing address:
  • Phone: 747-324-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YESIKA YOHANA ORTIZ VELEZ
Title or Position: OWNER
Credential:
Phone: 747-324-7797