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General NPI Number Information
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NPI Number | 1376205229
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Entity Type | Organization
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Legal Business Name | ONE SHOT BEAUTY MEDSPA
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 7938 W 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90048-4305
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Country | US
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Telephone | 310-866-8529
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Fax |
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Provider Business Mailing Address
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Address Line | 10736 JEFFERSON BLVD # 170
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City | CULVER CITY
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State | CA
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Zip | 90230-4933
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Country | US
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Telephone | 310-866-8529
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAYA SHOT BEAUTY KULANGARA
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Credential | NP
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Telephone | 310-866-8529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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