Healthcare Provider Details

I. General information

NPI: 1871998682
Provider Name (Legal Business Name): HAIR LOSS SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9917 HIDDEN RIVER DR APT 108
ORLANDO FL
32829-8594
US

IV. Provider business mailing address

9917 HIDDEN RIVER DR APT 108
ORLANDO FL
32829-8594
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-1958
  • Fax:
Mailing address:
  • Phone: 407-286-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA L FREEMAN
Title or Position: OWNER
Credential:
Phone: 321-632-8855