Healthcare Provider Details

I. General information

NPI: 1043763683
Provider Name (Legal Business Name): YAMAYA RESPUS CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 WEBBTOWN RD
MAPLE HILL NC
28454-8003
US

IV. Provider business mailing address

1145 WEBBTOWN RD
MAPLE HILL NC
28454-8003
US

V. Phone/Fax

Practice location:
  • Phone: 910-789-3479
  • Fax:
Mailing address:
  • Phone: 910-789-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberC 104130
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: