Healthcare Provider Details

I. General information

NPI: 1912238114
Provider Name (Legal Business Name): URBAN TWIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 8TH ST # B
HANFORD CA
93230-3934
US

IV. Provider business mailing address

130 E 8TH ST # B
HANFORD CA
93230-3934
US

V. Phone/Fax

Practice location:
  • Phone: 559-587-9545
  • Fax:
Mailing address:
  • Phone: 559-587-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1642
License Number StateCA

VIII. Authorized Official

Name: GEORGIA NICOLE ROGERS
Title or Position: OWNER
Credential:
Phone: 559-587-9545