Healthcare Provider Details

I. General information

NPI: 1043966443
Provider Name (Legal Business Name): RONDA'S MEDICAL WIGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 PRAIRIE AVE STE B
LAWNDALE CA
90260-3009
US

IV. Provider business mailing address

16815 STE B PRARIE AVE
LAWNDALE CA
90260-3009
US

V. Phone/Fax

Practice location:
  • Phone: 424-215-2105
  • Fax: 424-675-4064
Mailing address:
  • Phone: 310-370-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: LA RONDA HUNTER
Title or Position: CEO
Credential: PROSTHETIC/ORTHOTIC
Phone: 310-370-7757