MEDICARE: BEAUTIQUE SALON

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	1744P3200X	Prosthetics Case Management	KK482064	CA

General Provider Information

NPI Number	:	1952817272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIQUE SALON

Provider Business Mailing Address
First Line	:	1186 S 2ND ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-5914
Country	:	US
Telephone Number	:	408-460-8070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1186 S 2ND ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-5914
Country	:	US
Telephone Number	:	408-460-8070
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHARELLE NICOLE LOUDD
Credential	:	CERTIFIED HAIR-LOSS
Telephone Number	:	408-460-8070

Provider Enumeration Date	:	12/22/2017
Last Update Date	:	12/22/2017

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Directions to “BEAUTIQUE SALON ” Practice Location

Language	Start Address	Practice Location

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