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NPI Code Detail

MEDICARE: F8THFULHAIRCOMPANYLLC

MEDICARE: F8THFULHAIRCOMPANYLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1902687031
Entity Type Code : Organization
Provider Name (Legal Business Name) : F8THFULHAIRCOMPANYLLC
Provider Business Mailing Address
First Line : 3101 OCEAN PARK BLVD STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3029
Country : US
Telephone Number : 323-972-8924
Fax Number :
Provider Business Practice Location Address
First Line : 3101 OCEAN PARK BLVD STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3029
Country : US
Telephone Number : 323-972-8924
Fax Number :
Authorized Official
Title or Position : OWNER/CRANIAL PROSTHETIC SPECIALIST
Name : REGINA JACKSON
Credential :
Telephone Number : 323-972-8924
Provider Enumeration Date : 10/13/2023
Last Update Date : 10/19/2023

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Directions to “F8THFULHAIRCOMPANYLLC ” Practice Location

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