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General NPI Number Information
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NPI Number | 1073285409
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Entity Type | Organization
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Legal Business Name | CB THE BRAND
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 13907 VAN NESS AVE
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City | GARDENA
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State | CA
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Zip | 90249
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Country | US
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Telephone | 310-817-4243
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Fax | 323-800-8358
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Provider Business Mailing Address
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Address Line | 13907 VAN NESS AVE
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City | GARDENA
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State | CA
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Zip | 90249-2913
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Country | US
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Telephone | 310-817-7424
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Fax | 323-800-8358
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Authorized Official
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Title or Position | OWNER
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Name | MS. LACHELLE JOHNSON
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Credential |
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Telephone | 310-817-4243
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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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