| Organization Name: | ETERNAL BEAUTY MEDICAL CLINIC, INC |
| NPI Number: | 1033282892 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FOROUZAN VAGHAR (PRESIDENT) |
| Mailing Address: | 248 Los Gatos Saratoga Rd Los Gatos |
| State: | CA US |
| Postal Code: | 950305317 |
| Phone Number: | 4083543587 |
| Fax Number: | 4083543651 |
| NPI Enumeration Date: | 11/17/2006 |
| NPI Last Update Date: | 07/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | A063086 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |