Provider Demographics
NPI:1316292741
Name:BEAUTIFUL SKIN ESSENTIALS INC
Entity type:Organization
Organization Name:BEAUTIFUL SKIN ESSENTIALS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MOZIA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN,BS-BUSI MGT
Authorized Official - Phone:800-539-5980
Mailing Address - Street 1:1611 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3123
Mailing Address - Country:US
Mailing Address - Phone:800-539-5980
Mailing Address - Fax:
Practice Address - Street 1:16420 PERRIS BLVD
Practice Address - Street 2:SUITE #L
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1135
Practice Address - Country:US
Practice Address - Phone:424-703-3767
Practice Address - Fax:310-539-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163WR0006X, 164X00000X
CA11282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty