Healthcare Provider Details

I. General information

NPI: 1770950859
Provider Name (Legal Business Name): ACCENT PERMANENT MAKEUP STUDIO,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29377 RANCHO CALIFORNIA RD
TEMECULA CA
92591-5289
US

IV. Provider business mailing address

43343 CORTE RIALTO
TEMECULA CA
92592-3059
US

V. Phone/Fax

Practice location:
  • Phone: 909-528-1309
  • Fax: 951-695-7770
Mailing address:
  • Phone: 909-528-1309
  • Fax: 951-695-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DAWN PERCER
Title or Position: OWNER ARTIST
Credential:
Phone: 909-528-1309