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General NPI Number Information
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NPI Number | 1013621465
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Entity Type | Organization
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Legal Business Name | LELITE HAIR AND MORE BEAUTY STUDIO LLC
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 28441 S TAMIAMI TRL STE 108
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3213
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Country | US
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Telephone | 239-465-6163
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Fax |
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Provider Business Mailing Address
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Address Line | 27499 RIVERVIEW CENTER BLVD STE 110
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4329
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Country | US
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Telephone | 239-465-6163
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LINDA ELISCA
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Credential | COSMETOLOGY
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Telephone | 239-465-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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