Provider Demographics
NPI:1780787101
Name:CREATIVE WOMAN INC
Entity type:Organization
Organization Name:CREATIVE WOMAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMP
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-358-6216
Mailing Address - Street 1:1530 S MYRTLE AV
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016
Mailing Address - Country:US
Mailing Address - Phone:626-358-6216
Mailing Address - Fax:626-358-7810
Practice Address - Street 1:1530 S MYRTLE AV
Practice Address - Street 2:CREATIVE WOMAN
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016
Practice Address - Country:US
Practice Address - Phone:626-358-6216
Practice Address - Fax:626-358-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13472ZOtherBLUE SHIELD
CA5070640001Medicare ID - Type Unspecified