Healthcare Provider Details

I. General information

NPI: 1699459628
Provider Name (Legal Business Name): HAIR PHAZEZ HAIR LOSS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 FM 2920 RD # 122
SPRING TX
77379-2208
US

IV. Provider business mailing address

21838 CATOOSA DR
SPRING TX
77388-6900
US

V. Phone/Fax

Practice location:
  • Phone: 832-922-0682
  • Fax:
Mailing address:
  • Phone: 183-292-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NICOLE RENEE ROBINSON
Title or Position: OWNER
Credential:
Phone: 832-922-0682