Healthcare Provider Details

I. General information

NPI: 1548111420
Provider Name (Legal Business Name): LIFESPANBEAUTY SALON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N PACIFIC COAST HWY 2000-7025
EL SEGUNDO CA
90245
US

IV. Provider business mailing address

222 N PACIFIC COAST HWY 2000-7025
EL SEGUNDO CA
90245
US

V. Phone/Fax

Practice location:
  • Phone: 213-377-8989
  • Fax:
Mailing address:
  • Phone: 213-377-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMIE TERRY
Title or Position: OWNER
Credential: CPS
Phone: 213-377-8989