Provider Demographics
NPI:1346972221
Name:SELECT COSMETIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SELECT COSMETIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-800-8859
Mailing Address - Street 1:4905 RIVERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2326
Mailing Address - Country:US
Mailing Address - Phone:678-800-8859
Mailing Address - Fax:
Practice Address - Street 1:1832 INDEPENDENCE SQ STE D
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5166
Practice Address - Country:US
Practice Address - Phone:678-800-8859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty