Provider Demographics
NPI:1033282892
Name:ETERNAL BEAUTY MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:ETERNAL BEAUTY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FOROUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAGHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-354-3587
Mailing Address - Street 1:248 LOS GATOS SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5317
Mailing Address - Country:US
Mailing Address - Phone:408-354-3587
Mailing Address - Fax:408-354-3651
Practice Address - Street 1:248 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5317
Practice Address - Country:US
Practice Address - Phone:408-354-3587
Practice Address - Fax:408-354-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063086261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care