Healthcare Provider Details

I. General information

NPI: 1053226621
Provider Name (Legal Business Name): KREATIVE TOUCHEZ HAIR AND BEAUTY SUPPLY L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11875 W MCDOWELL RD APT 2188
AVONDALE AZ
85392-3115
US

IV. Provider business mailing address

11875 W MCDOWELL RD APT 2188
AVONDALE AZ
85392-3115
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-0413
  • Fax:
Mailing address:
  • Phone: 602-730-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHALA WILSON
Title or Position: CEO
Credential:
Phone: 602-730-0413