| Mane Of Your Dream | |
|
11553 Foothill Blvd Ste 101 Rancho Cucamonga CA 91730-0731 | |
| (909) 969-1833 | |
| Not Available |
| Full Name | Mane Of Your Dream |
|---|---|
| Speciality | Prosthetic/orthotic Supplier |
| Location | 11553 Foothill Blvd Ste 101, Rancho Cucamonga, California |
| Authorized Official Name and Position | Patsy Gallian (BILLING/CRENDENTIALING) |
| Authorized Official Contact | 2144372272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mane Of Your Dream 10210 Baseline Rd Spc 267 Alta Loma CA 91701-6048 Ph: () - | Mane Of Your Dream 11553 Foothill Blvd Ste 101 Rancho Cucamonga CA 91730-0731 Ph: (909) 969-1833 |
| NPI Number | 1629603741 |
|---|---|
| Provider Enumeration Date | 03/09/2020 |
| Last Update Date | 03/09/2020 |
| Certification Date | 03/09/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629603741 | NPI | - | NPPES |
| KK347413 | Other | CA | COSMETOLOGY LICENSE |
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