Healthcare Provider Details

I. General information

NPI: 1851767321
Provider Name (Legal Business Name): LOREN'S HAIR STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 NORTH FWY SUITE 214
HOUSTON TX
77037-1108
US

IV. Provider business mailing address

11003 WICKLOWE ST
HOUSTON TX
77016-1871
US

V. Phone/Fax

Practice location:
  • Phone: 713-823-9952
  • Fax:
Mailing address:
  • Phone: 713-823-9952
  • 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: LOREN DE'ANN HAYNES
Title or Position: OWNER/HAIR STYLIST
Credential:
Phone: 713-823-9952