MEDICARE: BEAUTOLOGIE FRESNO, INC

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	208200000X	Plastic Surgery Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1093471948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTOLOGIE FRESNO, INC

Provider Business Mailing Address
First Line	:	9491 N FORT WASHINGTON RD # 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-0660
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9491 N FORT WASHINGTON RD # 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-0660
Country	:	US
Telephone Number	:	661-327-3800
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DARSHAN SHAH
Credential	:	MD
Telephone Number	:	661-327-3800

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/23/2021

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Directions to “BEAUTOLOGIE FRESNO, INC ” Practice Location

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