Organization
LA LY
Active
Other names
Miracly Store
Organization subpart
No
Provider details
NPI number
Authorized official
LA LY (OWNER)
(559) 981-2787
Entity
Organization
Contact information
Practice address
1452 W SHAW AVE, FRESNO, CA 93711-3607
(559) 981-2787
Mailing address
1452 W SHAW AVE, FRESNO, CA 93711-3607
(559) 981-2787
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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