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General NPI Number Information
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NPI Number | 1154991966
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Entity Type | Organization
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Legal Business Name | UPTOWN NEW YORK STYLE INC
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 524 STEVENS AVE STE 9
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2053
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Country | US
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Telephone | 858-259-6833
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Fax | 760-476-0153
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Provider Business Mailing Address
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Address Line | 2914 LUCIERNAGA ST UNIT A
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City | CARLSBAD
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State | CA
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Zip | 92009-5951
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Country | US
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Telephone | 619-820-0290
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. LOUTICIA GRIER
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Credential | COSMETOLOGIST
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Telephone | 858-259-6833
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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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