Provider Demographics
NPI:1477319143
Name:LULU'S LICE REMOVAL CLINIC, LLC
Entity Type:Organization
Organization Name:LULU'S LICE REMOVAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-909-9414
Mailing Address - Street 1:5263 MILLER BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6224
Mailing Address - Country:US
Mailing Address - Phone:727-410-7013
Mailing Address - Fax:
Practice Address - Street 1:5810 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-6050
Practice Address - Country:US
Practice Address - Phone:727-410-7013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service