Provider Demographics
NPI:1386277002
Name:CINDERELLA'S CLOSET YOUR SPECIALTY LINGERIE BOUTIQUE
Entity type:Organization
Organization Name:CINDERELLA'S CLOSET YOUR SPECIALTY LINGERIE BOUTIQUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/FITTER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:951-758-8827
Mailing Address - Street 1:6886 RIVERRUN CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3437
Mailing Address - Country:US
Mailing Address - Phone:951-790-3039
Mailing Address - Fax:
Practice Address - Street 1:9651 BUSINESS CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4562
Practice Address - Country:US
Practice Address - Phone:951-758-8827
Practice Address - Fax:951-758-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty