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General NPI Number Information
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NPI Number | 1871061895
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Entity Type | Organization
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Legal Business Name | SILHOUETTEPOST SURGICAL & CUSTOM LINGERIE LLC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 7055 N MAPLE AVE STE 108
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City | FRESNO
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State | CA
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Zip | 93720-8012
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Country | US
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Telephone | 559-326-8491
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Fax | 559-765-4405
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Provider Business Mailing Address
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Address Line | 10490 E CEDARWOOD CT
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City | CLOVIS
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State | CA
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Zip | 93619-4637
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Country | US
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Telephone | 559-326-8491
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Fax | 559-765-4405
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Authorized Official
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Title or Position | AUTHORIZED ADMINISTRATOR
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Name | MS. BENTA JEAN FRIES ROBERTSON
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Credential | CMF
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Telephone | 559-326-8491
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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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