Healthcare Provider Details

I. General information

NPI: 1013909308
Provider Name (Legal Business Name): LINGERIE LINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8209 ROUGHRIDER DR SUITE 102
SAN ANTONIO TX
78239-2434
US

IV. Provider business mailing address

PO BOX 18301
SAN ANTONIO TX
78218-0301
US

V. Phone/Fax

Practice location:
  • Phone: 210-656-4090
  • Fax: 210-946-5471
Mailing address:
  • Phone: 210-656-4090
  • Fax: 210-946-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA B RAMIREZ
Title or Position: OWNER
Credential:
Phone: 210-656-4090