Provider Demographics
NPI:1598017436
Name:LADY LIKE LINGERIE, LLC
Entity Type:Organization
Organization Name:LADY LIKE LINGERIE, LLC
Other - Org Name:LADY LIKE MASTECTOMY BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTINAS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:210-655-1300
Mailing Address - Street 1:2379 NE LOOP 410
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5666
Mailing Address - Country:US
Mailing Address - Phone:210-655-1300
Mailing Address - Fax:
Practice Address - Street 1:2379 NE LOOP 410
Practice Address - Street 2:SUITE 3B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5666
Practice Address - Country:US
Practice Address - Phone:210-655-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LADY LIKE LINGERIE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies