Provider Demographics
NPI:1326408451
Name:REJUVENATING SKIN CARE MEDICAL AESTHETICS
Entity Type:Organization
Organization Name:REJUVENATING SKIN CARE MEDICAL AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:LYNDA
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-590-1632
Mailing Address - Street 1:709 W BEVERLY BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3600
Mailing Address - Country:US
Mailing Address - Phone:323-726-9692
Mailing Address - Fax:
Practice Address - Street 1:709 W BEVERLY BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3600
Practice Address - Country:US
Practice Address - Phone:323-726-9692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16811363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty