=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922726231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZEINEI HAIR LOSS SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2022
-----------------------------------------------------
Last Update Date | 08/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 S HANCOCK DR
-----------------------------------------------------
City | DELTONA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32725-6476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-715-7776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 809 S HANCOCK DR
-----------------------------------------------------
City | DELTONA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32725-6476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-715-7776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | THALINA GIBBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-715-7776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------