MEDICARE: LEIGHA JANIECE BURGS HAIR LOSS SPECIALIST

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1902309321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGHA JANIECE BURGS HAIR LOSS SPECIALIST

Provider Business Mailing Address
First Line	:	2012 ORCHARD SPRING DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-2239
Country	:	US
Telephone Number	:	281-808-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	6509 WESTHEIMER RD UNIT 6511
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5145
Country	:	US
Telephone Number	:	832-767-2328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2018

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