Healthcare Provider Details

I. General information

NPI: 1629782685
Provider Name (Legal Business Name): BEAUTY HIDDEN GEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W COLONIAL DR
ORLANDO FL
32804-7336
US

IV. Provider business mailing address

1015 W COLONIAL DR
ORLANDO FL
32804-7336
US

V. Phone/Fax

Practice location:
  • Phone: 689-333-5188
  • Fax:
Mailing address:
  • Phone: 689-333-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDA MCLAREN
Title or Position: CEO
Credential:
Phone: 689-333-5188