Provider Demographics
NPI:1316026875
Name:SKIN AND BEAUTY CENTER (SBC), INC.
Entity type:Organization
Organization Name:SKIN AND BEAUTY CENTER (SBC), INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJUNATH
Authorized Official - Middle Name:S
Authorized Official - Last Name:VADMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-857-0777
Mailing Address - Street 1:2720 W MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3034
Mailing Address - Country:US
Mailing Address - Phone:818-842-8000
Mailing Address - Fax:818-478-7207
Practice Address - Street 1:23501 CINEMA DR STE 111
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5429
Practice Address - Country:US
Practice Address - Phone:661-258-3811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20415Medicare UPIN