Provider Demographics
NPI:1487687083
Name:STRUT HAIR SOLUTIONS INC.
Entity Type:Organization
Organization Name:STRUT HAIR SOLUTIONS INC.
Other - Org Name:CITY WIGS AND BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-225-5691
Mailing Address - Street 1:202 LOMAS SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1224
Mailing Address - Country:US
Mailing Address - Phone:858-755-9447
Mailing Address - Fax:
Practice Address - Street 1:202 LOMAS SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1224
Practice Address - Country:US
Practice Address - Phone:858-755-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100-189479335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5495230001Medicare ID - Type UnspecifiedMEDICARE