Healthcare Provider Details

I. General information

NPI: 1043641152
Provider Name (Legal Business Name): SAND COSMETIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2013
Last Update Date: 12/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 WESTWOOD BLVD SUITE #125
LOS ANGELES CA
90025-4651
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 310-441-2263
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY FAYE SAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-792-3914