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General NPI Number Information
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NPI Number | 1245000249
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Entity Type | Organization
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Legal Business Name | FLAWLESS SKIN IV HYDRATION MED SPA
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 25101 THE OLD RD
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City | STEVENSON RANCH
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State | CA
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Zip | 91381-2206
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Country | US
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Telephone | 323-538-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 25101 THE OLD RD
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City | STEVENSON RANCH
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State | CA
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Zip | 91381-2206
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Country | US
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Telephone | 323-538-1110
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. EDITH ELLIS
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Credential | DNP,MSN,CNL,RN
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Telephone | 323-538-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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