Healthcare Provider Details

I. General information

NPI: 1932058260
Provider Name (Legal Business Name): EXQUISITE BOUTIQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 W ENTERTAINMENT BLVD SUITE 1057
GLENDALE AZ
85305
US

IV. Provider business mailing address

6610 N 93RD AVE APT 1057
GLENDALE AZ
85305-3186
US

V. Phone/Fax

Practice location:
  • Phone: 602-960-5868
  • Fax:
Mailing address:
  • Phone: 602-960-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. CEAIRA S JOHNSON
Title or Position: DIRECTOR/PESIDENT
Credential: JOHNSON
Phone: 602-960-5868