Provider Demographics
NPI:1215640230
Name:HAIR REPLACEMENT BY ITZEL LLC
Entity type:Organization
Organization Name:HAIR REPLACEMENT BY ITZEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HAIR REPLACEMENT EXPERT
Authorized Official - Prefix:
Authorized Official - First Name:ITZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-342-2702
Mailing Address - Street 1:3471 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1253
Mailing Address - Country:US
Mailing Address - Phone:707-342-2702
Mailing Address - Fax:
Practice Address - Street 1:3471 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1253
Practice Address - Country:US
Practice Address - Phone:707-342-2702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies