Healthcare Provider Details

I. General information

NPI: 1225900194
Provider Name (Legal Business Name): BEAUTIFY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S GOLD AVE STE D
DEMING NM
88030-3755
US

IV. Provider business mailing address

122 S GOLD AVE STE D
DEMING NM
88030-3755
US

V. Phone/Fax

Practice location:
  • Phone: 575-642-3396
  • Fax:
Mailing address:
  • Phone: 575-642-3396
  • 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: DANIELLE REGALADO
Title or Position: NURSE PRACTIONER
Credential: FNP-BC
Phone: 575-642-3396