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General NPI Number Information
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NPI Number | 1982553731
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Entity Type | Organization
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Legal Business Name | IBODIED CRANIAL PROSTHETICS
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 2227 N GLENN AVE APT 202
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City | FRESNO
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State | CA
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Zip | 93704-6309
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Country | US
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Telephone | 213-697-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 2227 N GLENN AVE APT 202
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City | FRESNO
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State | CA
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Zip | 93704-6309
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Country | US
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Telephone | 213-697-1250
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Fax |
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Authorized Official
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Title or Position | SPECIALIST
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Name | BRITTANY GRIMMETT
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Credential | CRANIAL PROSTHESES
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Telephone | 618-960-0190
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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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Taxonomy #2
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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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