Provider Demographics
NPI:1487346524
Name:CRAFT YOUR BRA, INC.
Entity type:Organization
Organization Name:CRAFT YOUR BRA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFENHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-365-3770
Mailing Address - Street 1:11160 RANCHO CARMEL DR.
Mailing Address - Street 2:STE 106 #1064
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4674
Mailing Address - Country:US
Mailing Address - Phone:858-365-3770
Mailing Address - Fax:
Practice Address - Street 1:288 CAMPUS WAY
Practice Address - Street 2:SUITE #102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92096
Practice Address - Country:US
Practice Address - Phone:858-365-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies