MEDICARE: REFRESHED BEAUTY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1053028753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFRESHED BEAUTY, LLC

Provider Business Mailing Address
First Line	:	8227 CALLE PRIMERA NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5392
Country	:	US
Telephone Number	:	505-417-1413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 5TH ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-1312
Country	:	US
Telephone Number	:	505-417-1413
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CRYSTAL OTERO-GRIFFITH
Credential	:	CNP
Telephone Number	:	505-417-1413

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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Directions to “REFRESHED BEAUTY, LLC ” Practice Location

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