Healthcare Provider Details

I. General information

NPI: 1366365538
Provider Name (Legal Business Name): THE MAGNOLIA HAIR COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 SEQUOYAH RD
OAKLAND CA
94605-4553
US

IV. Provider business mailing address

3818 SEQUOYAH RD
OAKLAND CA
94605-4553
US

V. Phone/Fax

Practice location:
  • Phone: 877-990-4247
  • Fax:
Mailing address:
  • Phone: 877-990-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: LATRIECE TITUS
Title or Position: OWNER/COSMETOLOGIST
Credential:
Phone: 877-990-4247