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General NPI Number Information
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NPI Number | 1871309468
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Entity Type | Organization
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Legal Business Name | BOSSI GAL WIG ACADEMY
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 640 S SAN VICENTE BLVD STE 441
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City | LOS ANGELES
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State | CA
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Zip | 90048-4654
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Country | US
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Telephone | 323-244-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 640 S SAN VICENTE BLVD STE 441
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City | LOS ANGELES
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State | CA
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Zip | 90048-4654
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Country | US
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Telephone | 323-244-3322
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Fax |
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Authorized Official
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Title or Position | CRANIAL PROSTHESIS
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Name | YVONNE MINCY
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Credential | PROTHESIS MAKER
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Telephone | 323-244-3322
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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 |
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License Number State |
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