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General NPI Number Information
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NPI Number | 1972929461
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Entity Type | Organization
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Legal Business Name | MY WIG STUDIO
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 03/09/2014
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Provider Practice Location Address
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Address Line | 12543 WINERY DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8834
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Country | US
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Telephone | 909-952-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 12543 WINERY DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASMIN ACUNA BARNES
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Credential |
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Telephone | 909-952-4935
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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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