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General NPI Number Information
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NPI Number | 1760876833
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Entity Type | Organization
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Legal Business Name | HEALTHY HAIR SOLUTIONS HAIR LOSS CENTER LLC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 1549 LAKELAND HILLS BLVD STE A
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City | LAKELAND
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State | FL
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Zip | 33805-3207
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Country | US
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Telephone | 863-699-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 1549 LAKELAND HILLS BLVD STE A
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City | LAKELAND
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State | FL
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Zip | 33805-3207
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Country | US
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Telephone | 863-699-3704
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MS. LAVONNE D BOOKER
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Credential | OWNER
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Telephone | 863-688-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CE99890011
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License Number State | FL
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