=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881351740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEMCARE HEALTH & BEAUTY- BURBANK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2021
-----------------------------------------------------
Last Update Date | 11/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 851 N HOLLYWOOD WAY
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-2814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-357-5886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 851 N HOLLYWOOD WAY
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-2814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-357-5886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TERESA MITCHELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-357-5886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------