Healthcare Provider Details

I. General information

NPI: 1154997633
Provider Name (Legal Business Name): HAIR WITH A CAUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 S LA CIENEGA BLVD
LOS ANGELES CA
90035-3711
US

IV. Provider business mailing address

1523 S LA CIENEGA BLVD
LOS ANGELES CA
90035-3711
US

V. Phone/Fax

Practice location:
  • Phone: 424-288-4969
  • Fax:
Mailing address:
  • Phone: 424-288-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH MCDOWELL
Title or Position: OWNER
Credential:
Phone: 424-288-4969