Organization
HI FASHION BOUTIQUE
Active
Other names
Hi Fashion Wigs Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA DEL SOCCORRO WILSON OPERATOR, LICENSED (CEO/PRESIDENT/OWNER)
(210) 732-7070
Entity
Organization
Contact information
Practice address
4522 FREDERICKSBURG RD, A35, SAN ANTONIO, TX 78201-6521
(210) 732-7070
Mailing address
4522 FREDERICKSBURG RD, A35, SAN ANTONIO, TX 78201-6521
(210) 732-7070
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
691-021
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
691-021
TEXAS COSMETOLOGY
TX
Enumeration date
08/13/2006
Last updated
03/20/2011
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