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General NPI Number Information
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NPI Number | 1073928487
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Entity Type | Organization
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Legal Business Name | A BEAUTIFUL MIND, LLC.
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 07/03/2014
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Provider Practice Location Address
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Address Line | 1600 E LITTLE CREEK RD SUITE 315
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City | NORFOLK
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State | VA
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Zip | 23518-4136
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Country | US
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Telephone | 757-962-8640
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 E LITTLE CREEK RD SUITE 315
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City | NORFOLK
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State | VA
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Zip | 23518-4136
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Country | US
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Telephone | 757-962-8640
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MARLENE NATALEE OROSCO
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Credential |
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Telephone | 757-286-6054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2348
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License Number State | VA
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