Provider Demographics
NPI:1326804311
Name:SPAIN, MONET (MA, COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:MONET
Middle Name:
Last Name:SPAIN
Suffix:
Gender:F
Credentials:MA, COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 S BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-8034
Mailing Address - Country:US
Mailing Address - Phone:843-742-0704
Mailing Address - Fax:
Practice Address - Street 1:586 HIGHWAY 701 N UNIT B
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2473
Practice Address - Country:US
Practice Address - Phone:843-742-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other