Provider Demographics
NPI:1093153264
Name:BEAUTY VENOM HAIR LOSS CENTER
Entity Type:Organization
Organization Name:BEAUTY VENOM HAIR LOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED TRICHOLOGY PRACTICTIONER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYKE
Authorized Official - Suffix:
Authorized Official - Credentials:BAMGMT/ NTTI GRAD
Authorized Official - Phone:702-807-1498
Mailing Address - Street 1:7785 N DURANGO DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8000
Mailing Address - Country:US
Mailing Address - Phone:702-658-8866
Mailing Address - Fax:
Practice Address - Street 1:7785 N DURANGO DR
Practice Address - Street 2:SUITE 125
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8000
Practice Address - Country:US
Practice Address - Phone:702-658-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
NV335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty