Healthcare Provider Details

I. General information

NPI: 1275293417
Provider Name (Legal Business Name): EXOTIC LOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S BELLAIRE ST STE 106
DENVER CO
80222-4931
US

IV. Provider business mailing address

PO BOX 221575
DENVER CO
80222-1015
US

V. Phone/Fax

Practice location:
  • Phone: 720-290-8608
  • Fax:
Mailing address:
  • Phone: 720-290-8608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: BERTA BACHAYEVA
Title or Position: OWNER /EMPLOYEE
Credential:
Phone: 720-290-8608