Provider Demographics
NPI:1033962725
Name:CHIC GLAM SLAY
Entity Type:Organization
Organization Name:CHIC GLAM SLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN,COSMETOLOGIST
Authorized Official - Phone:323-875-3099
Mailing Address - Street 1:860 E CARSON ST STE 114
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-7948
Mailing Address - Country:US
Mailing Address - Phone:323-870-1413
Mailing Address - Fax:
Practice Address - Street 1:17820 FIRTREE CT
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1696
Practice Address - Country:US
Practice Address - Phone:323-875-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier