Provider Demographics
NPI:1871062539
Name:JOVANCE BEAUTY AND HEALTH SPA, INC.
Entity type:Organization
Organization Name:JOVANCE BEAUTY AND HEALTH SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-224-0744
Mailing Address - Street 1:1406 PINOLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1338
Mailing Address - Country:US
Mailing Address - Phone:510-223-2900
Mailing Address - Fax:
Practice Address - Street 1:1406 PINOLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1338
Practice Address - Country:US
Practice Address - Phone:510-223-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier