Provider Demographics
NPI:1356803027
Name:WILSHIRE WIGS & ACCESSORIES INC.
Entity type:Organization
Organization Name:WILSHIRE WIGS & ACCESSORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR O OPERATIONS
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LOVELL-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-936-3785
Mailing Address - Street 1:5241 CRANER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3311
Mailing Address - Country:US
Mailing Address - Phone:818-635-5155
Mailing Address - Fax:
Practice Address - Street 1:5241 CRANER AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3311
Practice Address - Country:US
Practice Address - Phone:818-635-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies