Provider Demographics
NPI:1851185730
Name:BEAUTIFIED IV SPA
Entity type:Organization
Organization Name:BEAUTIFIED IV SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:213-925-8114
Mailing Address - Street 1:349 S LAFAYETTE PARK PLACE
Mailing Address - Street 2:125
Mailing Address - City:LOS ANGELES CA
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-840-7247
Mailing Address - Fax:
Practice Address - Street 1:349 S LAFAYETTE PARK PLACE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES CA
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-840-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty