Provider Demographics
NPI:1881131613
Name:SKIN AND BEAUTY CENTER (SBC), INC. - GLENDALE
Entity type:Organization
Organization Name:SKIN AND BEAUTY CENTER (SBC), INC. - GLENDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-842-8000
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0853
Mailing Address - Country:US
Mailing Address - Phone:778-222-2238
Mailing Address - Fax:818-842-3208
Practice Address - Street 1:1818 VERDUGO BLVD STE 304
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1444
Practice Address - Country:US
Practice Address - Phone:818-790-3588
Practice Address - Fax:323-935-8804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN AND BEAUTY CENTER (SBC), INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-31
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20415Medicare UPIN