Healthcare Provider Details

I. General information

NPI: 1689579773
Provider Name (Legal Business Name): FACEBOD MEDSPA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 FOOTHILL BLVD # 1
LA VERNE CA
91750-2902
US

IV. Provider business mailing address

2117 FOOTHILL BLVD # 1
LA VERNE CA
91750-2902
US

V. Phone/Fax

Practice location:
  • Phone: 909-755-8741
  • Fax:
Mailing address:
  • Phone: 909-755-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANIKA MUTHIAH
Title or Position: PRESIDENT
Credential: MD
Phone: 818-800-9273