Healthcare Provider Details

I. General information

NPI: 1669209425
Provider Name (Legal Business Name): HER FACE & BODY REJUVENATION CENTER, NURSING CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11553 FOOTHILL BLVD STE 22
RANCHO CUCAMONGA CA
91730-0730
US

IV. Provider business mailing address

11553 FOOTHILL BLVD STE 22
RANCHO CUCAMONGA CA
91730-0730
US

V. Phone/Fax

Practice location:
  • Phone: 909-286-7846
  • Fax: 909-265-9406
Mailing address:
  • Phone: 909-286-7846
  • Fax: 909-265-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERRI L. HULL
Title or Position: CEO/NP
Credential: NP
Phone: 661-449-7957