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General NPI Number Information
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NPI Number | 1033962725
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Entity Type | Organization
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Legal Business Name | CHIC GLAM SLAY
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 17820 FIRTREE CT
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City | CARSON
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State | CA
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Zip | 90746-1696
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Country | US
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Telephone | 323-875-3099
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Fax |
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Provider Business Mailing Address
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Address Line | 860 E CARSON ST STE 114
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City | CARSON
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State | CA
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Zip | 90745-7948
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Country | US
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Telephone | 323-870-1413
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MONICA RODRIQUEZ
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Credential | RN,COSMETOLOGIST
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Telephone | 323-875-3099
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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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