Healthcare Provider Details

I. General information

NPI: 1346862042
Provider Name (Legal Business Name): EXQUISITE BEAUTY HAIR REPLACEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 CROSSWAYS BLVD
CHESAPEAKE VA
23320-0206
US

IV. Provider business mailing address

109G GAINSBOROUGH SQ # 162
CHESAPEAKE VA
23320-1707
US

V. Phone/Fax

Practice location:
  • Phone: 757-567-2698
  • Fax:
Mailing address:
  • Phone: 757-567-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA RENA CORBIN
Title or Position: OWNER
Credential: HAIR LOSS PRACTITION
Phone: 757-567-2698