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General NPI Number Information
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NPI Number | 1225406945
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Entity Type | Organization
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Legal Business Name | SKIN CARE AND COSMETICS BY CARMEN
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 113A POWELL DR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3526
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Country | US
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Telephone | 615-822-9055
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Fax |
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Provider Business Mailing Address
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Address Line | 113A POWELL DR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3526
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Country | US
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Telephone | 615-822-9055
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. CARMEN E REYES-VELEZ
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Credential |
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Telephone | 615-822-9055
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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 | 00028017
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License Number State | TN
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