Healthcare Provider Details

I. General information

NPI: 1851826150
Provider Name (Legal Business Name): TALAYIA ALLEN HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12353 BEAMER RD APT 603
HOUSTON TX
77089-5381
US

IV. Provider business mailing address

12353 BEAMER RD APT 603
HOUSTON TX
77089-5381
US

V. Phone/Fax

Practice location:
  • Phone: 262-497-3583
  • Fax:
Mailing address:
  • Phone: 262-497-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number1700812
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: