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General NPI Number Information
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NPI Number | 1043749518
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Entity Type | Organization
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Legal Business Name | E.M. EXOTIC HAIR CREATION & SUPPLY INC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 10300 FOREST HILL BLVD STE 270
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City | WELLINGTON
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State | FL
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Zip | 33414-3130
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Country | US
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Telephone | 561-200-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 10300 FOREST HILL BLVD
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City | WELLINGTON
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State | FL
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Zip | 33414-3120
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Country | US
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Telephone | 561-200-2820
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. EVELYN METELLUS
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Credential | HAIR LOSS SPECIALIST
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Telephone | 561-574-0597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CE10000534
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License Number State | FL
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