Provider Demographics
NPI:1689434029
Name:MYSTIQUE MINGLE LLC
Entity Type:Organization
Organization Name:MYSTIQUE MINGLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-331-4317
Mailing Address - Street 1:300 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HURLOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21643-3543
Mailing Address - Country:US
Mailing Address - Phone:443-331-4317
Mailing Address - Fax:
Practice Address - Street 1:300 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21643-3543
Practice Address - Country:US
Practice Address - Phone:443-331-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies