Provider Demographics
NPI:1801460712
Name:PRETTY GIRLZVIRGIN HAIR
Entity type:Organization
Organization Name:PRETTY GIRLZVIRGIN HAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMIESA
Authorized Official - Middle Name:RASHIDA
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-789-2338
Mailing Address - Street 1:626 N AUSTIN BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2531
Mailing Address - Country:US
Mailing Address - Phone:214-789-2338
Mailing Address - Fax:
Practice Address - Street 1:626 N AUSTIN BLVD APT 7
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2531
Practice Address - Country:US
Practice Address - Phone:214-789-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRETTY GIRLZ VIRGIN HAIR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier