Healthcare Provider Details

I. General information

NPI: 1902309321
Provider Name (Legal Business Name): LEIGHA JANIECE BURGS HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 WESTHEIMER RD UNIT 6511
HOUSTON TX
77057-5145
US

IV. Provider business mailing address

2012 ORCHARD SPRING DR
PEARLAND TX
77581-2239
US

V. Phone/Fax

Practice location:
  • Phone: 832-767-2328
  • Fax:
Mailing address:
  • Phone: 281-808-4312
  • 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:
Title or Position:
Credential:
Phone: