Organization
MANE OF YOUR DREAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATSY GALLIAN (BILLING/CRENDENTIALING)
(214) 437-2272
Entity
Organization
Contact information
Practice address
11553 FOOTHILL BLVD STE 101, RANCHO CUCAMONGA, CA 91730-0731
(909) 969-1833
Mailing address
10210 BASELINE RD SPC 267, ALTA LOMA, CA 91701-6048
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1744P3200X
Prosthetics Case Management
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KK347413
COSMETOLOGY LICENSE
CA
Enumeration date
03/09/2020
Last updated
03/09/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up