Provider Demographics
NPI:1043744253
Name:SUSAN'S HAIR UNLIMITED ,INC
Entity Type:Organization
Organization Name:SUSAN'S HAIR UNLIMITED ,INC
Other - Org Name:HAIR UNLIMITED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-299-6060
Mailing Address - Street 1:1400 CAMINO DE LA REINA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1512
Mailing Address - Country:US
Mailing Address - Phone:619-299-6060
Mailing Address - Fax:619-299-5379
Practice Address - Street 1:1400 CAMINO DE LA REINA
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1512
Practice Address - Country:US
Practice Address - Phone:619-299-6060
Practice Address - Fax:619-299-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies