Provider Demographics
NPI:1932101250
Name:NEXT STEP A WOMANS BOUTIQUE LLC
Entity Type:Organization
Organization Name:NEXT STEP A WOMANS BOUTIQUE LLC
Other - Org Name:THE NEXT STEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TROBOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-358-8433
Mailing Address - Street 1:15400 NATIONAL AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2433
Mailing Address - Country:US
Mailing Address - Phone:408-358-8433
Mailing Address - Fax:408-358-8435
Practice Address - Street 1:15400 NATIONAL AVE
Practice Address - Street 2:STE 120
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2433
Practice Address - Country:US
Practice Address - Phone:408-358-8433
Practice Address - Fax:408-358-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1157750001Medicare ID - Type Unspecified