Provider Demographics
NPI:1851028500
Name:GLORIOUS STRANDS
Entity type:Organization
Organization Name:GLORIOUS STRANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MILLER
Authorized Official - Middle Name:
Authorized Official - Last Name:JANET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-370-6743
Mailing Address - Street 1:7761 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4950
Mailing Address - Country:US
Mailing Address - Phone:619-370-6743
Mailing Address - Fax:
Practice Address - Street 1:7761 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4950
Practice Address - Country:US
Practice Address - Phone:619-370-6743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier