Provider Demographics
NPI:1912285537
Name:BEAUTIFUL AMA, LLC
Entity Type:Organization
Organization Name:BEAUTIFUL AMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:651-769-7641
Mailing Address - Street 1:45 BAKER ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2972
Mailing Address - Country:US
Mailing Address - Phone:651-769-7641
Mailing Address - Fax:
Practice Address - Street 1:45 BAKER ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2972
Practice Address - Country:US
Practice Address - Phone:651-769-7641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-31
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty