Organization
BOUTIQUE DE LINGERIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNINE DIVINCENZO (OWNER)
(831) 635-0722
Entity
Organization
Contact information
Practice address
650 SAN BENITO ST STE 150, HOLLISTER, CA 95023-3968
(831) 635-0722
Mailing address
650 SAN BENITO ST STE 150, HOLLISTER, CA 95023-3968
(831) 635-0722
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
10/17/2007
Last updated
10/17/2007
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