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General NPI Number Information
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NPI Number | 1336682251
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Entity Type | Organization
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Legal Business Name | FAB FASHION LLC
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Dates
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Enumeration Date | 11/25/2016
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Last Update Date | 11/25/2016
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Provider Practice Location Address
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Address Line | 8519 E MARIPOSA DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-1828
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Country | US
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Telephone | 480-586-7540
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Fax |
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Provider Business Mailing Address
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Address Line | 8519 E MARIPOSA DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-1828
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Country | US
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Telephone | 480-586-7540
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Fax |
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MRS. LORRAINE BETH MCWHORTER
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Credential |
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Telephone | 480-580-6215
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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 | 21026027
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License Number State | AZ
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