Healthcare Provider Details

I. General information

NPI: 1699423368
Provider Name (Legal Business Name): STAY PRETTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218 CANYON CHASE DR
RICHMOND TX
77469-6224
US

IV. Provider business mailing address

6218 CANYON CHASE DR
RICHMOND TX
77469-6224
US

V. Phone/Fax

Practice location:
  • Phone: 832-681-1934
  • Fax:
Mailing address:
  • Phone: 832-681-1934
  • 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: SHANQURIA PORCH
Title or Position: OWNER
Credential:
Phone: 832-681-1934