Provider Demographics
NPI:1881402865
Name:CARTER'S COUTURE LUXURY MEDICAL WIGS
Entity type:Organization
Organization Name:CARTER'S COUTURE LUXURY MEDICAL WIGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROSTHESIS S
Authorized Official - Phone:510-697-9933
Mailing Address - Street 1:1721 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2124
Mailing Address - Country:US
Mailing Address - Phone:510-697-9933
Mailing Address - Fax:
Practice Address - Street 1:1721 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2124
Practice Address - Country:US
Practice Address - Phone:510-697-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier