Healthcare Provider Details

I. General information

NPI: 1881131613
Provider Name (Legal Business Name): SKIN AND BEAUTY CENTER (SBC), INC. - GLENDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 VERDUGO BLVD STE 304
GLENDALE CA
91208-1444
US

IV. Provider business mailing address

PO BOX 840853
LOS ANGELES CA
90084-0853
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-3588
  • Fax: 323-935-8804
Mailing address:
  • Phone: 778-222-2238
  • Fax: 818-842-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JENNIFER MONES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 818-842-8000