Organization
BEAUTICIANS ON THE GO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA R OLIVARES COSMETOLOGIST (CEO)
(602) 803-2827
Entity
Organization
Contact information
Practice address
2390 E CAMELBACK RD STE 130, PHOENIX, AZ 85016-3449
(602) 803-2827
(602) 218-4498
Mailing address
PO BOX 74322, NEW RIVER, AZ 85087-1006
(602) 803-2728
(602) 218-4498
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
10223435
AZ
253Z00000X
In Home Supportive Care Agency
10223435
AZ
305S00000X
Point of Service
10223435
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972015105
NON- MEDICARE
AZ
05
—
1972015105
—
AZ
Enumeration date
10/27/2017
Last updated
04/18/2018
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