MEDICARE: BEAUTIFUL AFFECTATION

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	225400000X	Rehabilitation Practitioner
2	251V00000X	Voluntary or Charitable Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750886289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL AFFECTATION

Provider Business Mailing Address
First Line	:	1415 ARVILLE ST STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0536
Country	:	US
Telephone Number	:	702-353-6738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 ARVILLE ST STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0536
Country	:	US
Telephone Number	:	702-626-7637
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. PATRICE BINGHAM
Credential	:
Telephone Number	:	702-626-7637

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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Directions to “BEAUTIFUL AFFECTATION ” Practice Location

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