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General NPI Number Information
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NPI Number | 1225650666
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Entity Type | Organization
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Legal Business Name | BOOB SHOP
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 4900 BROADWAY ST STE 700
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City | SAN ANTONIO
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State | TX
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Zip | 78209-5739
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Country | US
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Telephone | 757-706-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 250 TREELINE PARK APT 302
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City | SAN ANTONIO
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State | TX
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Zip | 78209-7401
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Country | US
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Telephone | 757-706-5571
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BROOKE STRACHAN
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Credential |
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Telephone | 757-706-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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