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General NPI Number Information
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NPI Number | 1093153264
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Entity Type | Organization
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Legal Business Name | BEAUTY VENOM HAIR LOSS CENTER
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 7785 N DURANGO DR SUITE 125
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City | LAS VEGAS
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State | NV
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Zip | 89131-8000
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Country | US
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Telephone | 702-658-8866
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Fax |
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Provider Business Mailing Address
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Address Line | 7785 N DURANGO DR SUITE 125
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City | LAS VEGAS
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State | NV
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Zip | 89131-8000
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Country | US
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Telephone | 702-658-8866
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Fax |
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Authorized Official
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Title or Position | CERTIFIED TRICHOLOGY PRACTICTIONER
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Name | ASHLEY LYKE
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Credential | B.A.MGMT/ NTTI GRAD
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Telephone | 702-807-1498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State | GA
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