MEDICARE: GLORIOUS STRANDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1851028500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIOUS STRANDS

Provider Business Mailing Address
First Line	:	7761 UNIVERSITY AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-4950
Country	:	US
Telephone Number	:	619-370-6743
Fax Number	:

Provider Business Practice Location Address
First Line	:	7761 UNIVERSITY AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-4950
Country	:	US
Telephone Number	:	619-370-6743
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	MILLER JANET
Credential	:
Telephone Number	:	619-370-6743

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/03/2022

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Directions to “GLORIOUS STRANDS ” Practice Location

Language	Start Address	Practice Location

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