Healthcare Provider Details

I. General information

NPI: 1245693118
Provider Name (Legal Business Name): STEPHANIE BERARD CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 EASTWOOD ST
HOUSTON TX
77021-4244
US

IV. Provider business mailing address

6606 EASTWOOD ST
HOUSTON TX
77021-4244
US

V. Phone/Fax

Practice location:
  • Phone: 832-292-9120
  • Fax:
Mailing address:
  • Phone: 832-292-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberL784140626
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: