1942606793 NPI number — ELEGANCE BODY ENHANCEMENT CENTERS

Table of content: (NPI 1942606793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942606793 NPI number — ELEGANCE BODY ENHANCEMENT CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEGANCE BODY ENHANCEMENT CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942606793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 243
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76053-0243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-939-4974
Provider Business Mailing Address Fax Number:
972-939-4973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2008 E HEBRON PKWY
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75007-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-939-4974
Provider Business Practice Location Address Fax Number:
972-939-4973
Provider Enumeration Date:
11/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LOREDO
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-939-4974

Provider Taxonomy Codes

  • Taxonomy code: 2086S0105X , with the licence number:  N0228 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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