Provider Demographics
NPI:1376025288
Name:TEMECULA WIGS AND MORE
Entity Type:Organization
Organization Name:TEMECULA WIGS AND MORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:GRETCHEN
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-595-3433
Mailing Address - Street 1:31757 TEMECULA PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6813
Mailing Address - Country:US
Mailing Address - Phone:951-595-3433
Mailing Address - Fax:
Practice Address - Street 1:31757 TEMECULA PKWY STE F
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6813
Practice Address - Country:US
Practice Address - Phone:951-595-3433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK361269332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies