Healthcare Provider Details

I. General information

NPI: 1093471948
Provider Name (Legal Business Name): BEAUTOLOGIE FRESNO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9491 N FORT WASHINGTON RD # 101
FRESNO CA
93730-0660
US

IV. Provider business mailing address

9491 N FORT WASHINGTON RD # 101
FRESNO CA
93730-0660
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARSHAN SHAH
Title or Position: FOUNDER
Credential: MD
Phone: 661-327-3800