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General NPI Number Information
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NPI Number | 1801579883
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Entity Type | Organization
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Legal Business Name | NIRVANA BEAUTY AND LASER CENTER INC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 10 W SAINT CHARLES RD
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City | LOMBARD
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State | IL
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Zip | 60148-7402
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Country | US
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Telephone | 708-448-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W SAINT CHARLES RD
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City | LOMBARD
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State | IL
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Zip | 60148-7402
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Country | US
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Telephone | 708-448-9300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ATIYEH SALEM
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Credential | DPM
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Telephone | 708-448-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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