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General NPI Number Information
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NPI Number | 1518656925
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Entity Type | Organization
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Legal Business Name | RAVISH HAIR EXTENSIONS, LLC
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 12342 ASHLEY DR STE C
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City | GULFPORT
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State | MS
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Zip | 39503-2953
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Country | US
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Telephone | 228-547-1143
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Fax |
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Provider Business Mailing Address
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Address Line | 12342 ASHLEY DR STE C
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City | GULFPORT
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State | MS
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Zip | 39503-2953
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Country | US
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Telephone | 228-547-1143
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | NARQUITA BRIDGES
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Credential |
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Telephone | 228-314-3554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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