=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053226621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KREATIVE TOUCHEZ HAIR AND BEAUTY SUPPLY L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2026
-----------------------------------------------------
Last Update Date | 08/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11875 W MCDOWELL RD APT 2188
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-730-0413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11875 W MCDOWELL RD APT 2188
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-730-0413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHALA WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-730-0413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------