Healthcare Provider Details

I. General information

NPI: 1033022116
Provider Name (Legal Business Name): J HAIR PROSTHETICS & RESTORATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 BENTON RD STE M2
BOSSIER CITY LA
71111-3580
US

IV. Provider business mailing address

5144 TARA LN
BOSSIER CITY LA
71111-7809
US

V. Phone/Fax

Practice location:
  • Phone: 337-292-6029
  • Fax:
Mailing address:
  • Phone: 337-292-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTINA OSIFO
Title or Position: OWNER/MANAGER
Credential:
Phone: 337-292-6029