Organization
BLU HAVEN SALON LLC
Active
Other names
Blu Haven Cranial Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
GUERLINE DIVRA (OWNER/MANAGER)
(904) 431-2131
Entity
Organization
Contact information
Practice address
16259 TISONS BLUFF RD, JACKSONVILLE, FL 32218-0141
(904) 431-2131
Mailing address
731 DUVAL STATION RD, JACKSONVILLE, FL 32218-0800
(904) 431-2131
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/26/2026
Last updated
01/26/2026
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