Organization
LAURA'S CORSET SHOPPE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HALEY V TRIVOLI OWNER (CEO)
(818) 241-5616
Entity
Organization
Contact information
Practice address
232 N BRAND BLVD, GLENDALE, CA 91203-2610
(818) 241-5616
Mailing address
232 N BRAND BLVD, GLENDALE, CA 91203-2610
(818) 241-5616
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
17087789
CA
Other
Enumeration date
03/05/2007
Last updated
08/22/2020
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