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General NPI Number Information
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NPI Number | 1164208013
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Entity Type | Organization
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Legal Business Name | DESIRE EXOTIC HAIR LLC
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 8929 POCAHONTAS TRL
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City | PROVDENCE FRG
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State | VA
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Zip | 23140-3308
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Country | US
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Telephone | 718-730-4705
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Fax |
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Provider Business Mailing Address
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Address Line | 8929 POCAHONTAS TRL
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City | PROVDENCE FRG
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State | VA
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Zip | 23140-3308
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Country | US
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Telephone | 718-730-4705
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MIRIAM CHRISTIAN
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Credential |
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Telephone | 718-730-4705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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