Provider Demographics
NPI:1467580423
Name:MISS STEVENS FOR LINGERIE
Entity Type:Organization
Organization Name:MISS STEVENS FOR LINGERIE
Other - Org Name:LESLIE DIANE VAUGHN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:310-278-7987
Mailing Address - Street 1:2235 S SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1811
Mailing Address - Country:US
Mailing Address - Phone:310-278-7987
Mailing Address - Fax:310-278-2593
Practice Address - Street 1:2235 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1811
Practice Address - Country:US
Practice Address - Phone:310-278-7987
Practice Address - Fax:310-278-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1320270001Medicare NSC