Provider Demographics
NPI:1376357913
Name:BEAUTY GREEN SALON & HAIR EXTENSIONS, LLC
Entity type:Organization
Organization Name:BEAUTY GREEN SALON & HAIR EXTENSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YSDALY
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-607-3698
Mailing Address - Street 1:3812 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3002
Mailing Address - Country:US
Mailing Address - Phone:786-607-3698
Mailing Address - Fax:
Practice Address - Street 1:3812 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3002
Practice Address - Country:US
Practice Address - Phone:786-607-3698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty