Organization
ILLUSION HAIR INDUSTRIES LLC
Active
Other names
Hair Goddess Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
MISS OLAJIDE A WILKERSON (MANAGER)
(954) 471-5170
Entity
Organization
Contact information
Practice address
540 NW 165TH STREET RD STE 109, MIAMI, FL 33169-6304
(954) 471-5170
Mailing address
2728 DAVIE BLVD UNIT 73, FORT LAUDERDALE, FL 33312-2927
(954) 471-5170
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/23/2019
Last updated
02/23/2019
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