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General NPI Number Information
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NPI Number | 1366897779
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Entity Type | Organization
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Legal Business Name | HAIR LOSS SPEALIST
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1631 N COCOA BLVD
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City | COCOA
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State | FL
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Zip | 32922-6935
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Country | US
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Telephone | 321-632-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 1631 N. COCOA BLVD.
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City | COCOA
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State | FL
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Zip | 32922
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Country | US
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Telephone | 321-632-8855
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA L FREEMAN
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Credential |
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Telephone | 407-761-6238
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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 | BB29026
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License Number State | FL
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