Provider Demographics
NPI:1720882707
Name:MIRACLE HAIR STUDIO INC
Entity type:Organization
Organization Name:MIRACLE HAIR STUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-827-5885
Mailing Address - Street 1:2633 TELEGRAPH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1744
Mailing Address - Country:US
Mailing Address - Phone:510-827-5885
Mailing Address - Fax:510-663-1200
Practice Address - Street 1:2633 TELEGRAPH AVE STE 107
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1744
Practice Address - Country:US
Practice Address - Phone:510-827-5885
Practice Address - Fax:510-663-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty