Organization
MASTECTOMY BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH MISTRETTA (OWNER/PRESIDENT)
(352) 683-9991
Entity
Organization
Contact information
Practice address
3486 DELTONA BLVD, SPRING HILL, FL 34606-2997
(352) 683-9991
(352) 683-1599
Mailing address
3486 DELTONA BLVD, SPRING HILL, FL 34606-2997
(352) 683-9991
(352) 683-1599
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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