=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851185730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAUTIFIED IV SPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 S LAFAYETTE PARK PLACE
-----------------------------------------------------
City | LOS ANGELES CA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-840-7247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 349 S LAFAYETTE PARK PLACE 125
-----------------------------------------------------
City | LOS ANGELES CA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-840-7247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | FARIDAH MUMIN
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 213-925-8114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------