Healthcare Provider Details

I. General information

NPI: 1003770256
Provider Name (Legal Business Name): ELEGANT & CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4356 KRAFT AVE
STUDIO CITY CA
91604-2744
US

IV. Provider business mailing address

11054 VENTURA BLVD # 2702
STUDIO CITY CA
91604-3546
US

V. Phone/Fax

Practice location:
  • Phone: 929-884-2242
  • Fax:
Mailing address:
  • Phone: 929-884-2242
  • 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: OCTAYANNA BOUCAUD
Title or Position: OWNER
Credential:
Phone: 929-884-2242