Provider Demographics
NPI:1376205229
Name:ONE SHOT BEAUTY MEDSPA
Entity Type:Organization
Organization Name:ONE SHOT BEAUTY MEDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:SHOT BEAUTY
Authorized Official - Last Name:KULANGARA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-866-8529
Mailing Address - Street 1:10736 JEFFERSON BLVD # 170
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4933
Mailing Address - Country:US
Mailing Address - Phone:310-866-8529
Mailing Address - Fax:
Practice Address - Street 1:7938 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4305
Practice Address - Country:US
Practice Address - Phone:310-866-8529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty