Provider Demographics
NPI:1811234909
Name:BEAUTY SWE, MD, INC.
Entity Type:Organization
Organization Name:BEAUTY SWE, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAUTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-414-6549
Mailing Address - Street 1:301 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2561
Mailing Address - Country:US
Mailing Address - Phone:626-414-6549
Mailing Address - Fax:626-765-3552
Practice Address - Street 1:301 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2561
Practice Address - Country:US
Practice Address - Phone:626-414-6549
Practice Address - Fax:626-765-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54760Medicare PIN