Provider Demographics
NPI:1184669707
Name:LADY LIKE LINGERIE, LLC
Entity Type:Organization
Organization Name:LADY LIKE LINGERIE, LLC
Other - Org Name:LADY LIKE MASTECTOMY BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORTINAS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:210-655-1300
Mailing Address - Street 1:7419 CALLAGHAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2904
Mailing Address - Country:US
Mailing Address - Phone:210-655-1300
Mailing Address - Fax:210-615-1301
Practice Address - Street 1:7419 CALLAGHAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2904
Practice Address - Country:US
Practice Address - Phone:210-655-1300
Practice Address - Fax:210-615-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87726OtherSECURE HORIZONS DIRECT
TX1583215601Medicaid
TX183215602Medicaid
TX532420OtherBLUE CROSS BLUE SHIELD
TX=========OtherTRICARE
TX5743710001Medicare NSC