Provider Demographics
NPI:1528346806
Name:FEELING BEAUTIFUL AGAIN
Entity type:Organization
Organization Name:FEELING BEAUTIFUL AGAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-399-8511
Mailing Address - Street 1:1916 NEW JERSEY STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-399-8511
Mailing Address - Fax:707-434-9826
Practice Address - Street 1:1916 NEW JERSEY STREET
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-399-8511
Practice Address - Fax:707-434-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty