Healthcare Provider Details

I. General information

NPI: 1679498265
Provider Name (Legal Business Name): O'NEAL ELITE ELECTEOLYSIS AND SKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 HAWTHORNE BLVD
ENGLEWOOD CA
90304
US

IV. Provider business mailing address

578 WASHINGTON BLVD # 842
MARINA DEL REY CA
90292-5421
US

V. Phone/Fax

Practice location:
  • Phone: 747-322-1965
  • Fax:
Mailing address:
  • Phone: 747-322-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JESSE O'NEAL
Title or Position: OWNER
Credential:
Phone: 747-322-1965