Provider Demographics
NPI:1649914177
Name:SIAS, CHRISTIN ANN (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:ANN
Last Name:SIAS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4952
Mailing Address - Country:US
Mailing Address - Phone:337-520-1157
Mailing Address - Fax:
Practice Address - Street 1:1003 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-4552
Practice Address - Country:US
Practice Address - Phone:337-520-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224P00000X224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1744P3200XMedicaid
LA224P00000XOtherCERTIFIED HAIR LOSS SPECIALIST