Healthcare Provider Details

I. General information

NPI: 1982467478
Provider Name (Legal Business Name): NATURALISTIC BROWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 05/15/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13784 GOLDENWEST ST
WESTMINSTER CA
92683
US

IV. Provider business mailing address

3440 ARMOURDALE AVE
LONG BEACH CA
90808-3131
US

V. Phone/Fax

Practice location:
  • Phone: 407-982-4876
  • Fax: 407-650-2754
Mailing address:
  • Phone: 714-760-9993
  • Fax: 407-650-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: TAMIA HAYNES
Title or Position: OWNER
Credential:
Phone: 714-760-9993