Healthcare Provider Details

I. General information

NPI: 1730664087
Provider Name (Legal Business Name): SPOILED UNLIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5288 W 34TH ST STE 100
HOUSTON TX
77092-6624
US

IV. Provider business mailing address

2507 LACEWING LN
HOUSTON TX
77067-3317
US

V. Phone/Fax

Practice location:
  • Phone: 713-957-0014
  • Fax:
Mailing address:
  • Phone:
  • 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: DANIELLE SHIMFARR
Title or Position: HAIR REPLACEMENT SPECIALIST
Credential:
Phone: 713-957-0014