Provider Demographics
NPI:1073751129
Name:SKIN AND BEAUTY CENTER INC
Entity Type:Organization
Organization Name:SKIN AND BEAUTY CENTER INC
Other - Org Name:SBC - BURBANK
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJUNATH
Authorized Official - Middle Name:S
Authorized Official - Last Name:VADMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-842-8000
Mailing Address - Street 1:PO BOX 840853 SUITE 171
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0853
Mailing Address - Country:US
Mailing Address - Phone:778-222-2238
Mailing Address - Fax:818-842-3208
Practice Address - Street 1:2720 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3034
Practice Address - Country:US
Practice Address - Phone:818-842-8000
Practice Address - Fax:818-842-3208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN AND BEAUTY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-28
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20415Medicare UPIN