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General NPI Number Information
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NPI Number | 1972019628
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Entity Type | Organization
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Legal Business Name | EXTENSIONS BY TASHI LLC
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 560 N DIAMOND BAR BLVD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1007
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Country | US
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Telephone | 909-612-4295
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Fax |
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Provider Business Mailing Address
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Address Line | 560 N DIAMOND BAR BLVD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1007
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Country | US
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Telephone | 909-612-4295
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TASHI CARR
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Credential |
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Telephone | 951-232-4429
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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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