Provider Demographics
NPI:1114613056
Name:HAIR PHAZEZ HAIR LOSS CENTER LLC
Entity Type:Organization
Organization Name:HAIR PHAZEZ HAIR LOSS CENTER LLC
Other - Org Name:HAIR PHAZEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROSTHESIS
Authorized Official - Phone:832-922-0682
Mailing Address - Street 1:21838 CATOOSA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-6900
Mailing Address - Country:US
Mailing Address - Phone:832-922-0682
Mailing Address - Fax:
Practice Address - Street 1:7111 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2208
Practice Address - Country:US
Practice Address - Phone:832-922-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier