Healthcare Provider Details

I. General information

NPI: 1780442970
Provider Name (Legal Business Name): TEASED TRESSES DBA HAIR JUNKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 N LOS COYOTES DIAGONAL
LONG BEACH CA
90808-3750
US

IV. Provider business mailing address

6510 E SPRING ST # 917
LONG BEACH CA
90815-1554
US

V. Phone/Fax

Practice location:
  • Phone: 562-746-6592
  • Fax:
Mailing address:
  • Phone:
  • 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: BECKY BARNUM
Title or Position: OWNER
Credential:
Phone: 562-746-6592