MEDICARE: FEELING BEAUTIFUL AGAIN

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	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1528346806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEELING BEAUTIFUL AGAIN

Provider Business Mailing Address
First Line	:	1916 NEW JERSEY STREET
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533
Country	:	US
Telephone Number	:	707-399-8511
Fax Number	:	707-434-9826

Provider Business Practice Location Address
First Line	:	1916 NEW JERSEY STREET
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533
Country	:	US
Telephone Number	:	707-399-8511
Fax Number	:	707-434-9826

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CORINNE DEROSALES
Credential	:
Telephone Number	:	707-399-8511

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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Directions to “FEELING BEAUTIFUL AGAIN ” Practice Location

Language	Start Address	Practice Location

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