Provider Demographics
NPI:1336956820
Name:ILLUSIONS BY INK, LLC
Entity type:Organization
Organization Name:ILLUSIONS BY INK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:BERMEA
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OTHER
Authorized Official - Phone:916-912-3958
Mailing Address - Street 1:4835 N O'CONNOR ROAD
Mailing Address - Street 2:120
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:916-912-3958
Mailing Address - Fax:
Practice Address - Street 1:4835 N O'CONNOR ROAD
Practice Address - Street 2:120
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:916-912-3958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty