Healthcare Provider Details

I. General information

NPI: 1306756069
Provider Name (Legal Business Name): MICHELLE'S FANTASTIC HAIR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 NW 167TH ST
MIAMI LAKES FL
33014-6427
US

IV. Provider business mailing address

4728 NW 167TH ST
MIAMI LAKES FL
33014-6427
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-2328
  • Fax:
Mailing address:
  • Phone: 305-621-2328
  • 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: HECTOR RICARDO GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 305-742-1152