Healthcare Provider Details

I. General information

NPI: 1710358593
Provider Name (Legal Business Name): HAIR BY ANDREA HAIR LOSS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 CORPORATE DR W STE 104
ARLINGTON TX
76006-6813
US

IV. Provider business mailing address

1170 CORPORATE DR STE 104
ARLINGTON TX
76006
US

V. Phone/Fax

Practice location:
  • Phone: 817-548-8820
  • Fax:
Mailing address:
  • Phone: 817-548-8820
  • 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: ANDREA ROBINSON
Title or Position: OWNER
Credential:
Phone: 817-548-8820