Organization
YOUR IMAGE BOUTIQUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH LORRAINE MARTINEZ CMF (PRESIDENT/OWNER)
(915) 564-5923
Entity
Organization
Contact information
Practice address
3401 MONTANA AVE, EL PASO, TX 79903-4330
(915) 564-5923
(915) 565-1310
Mailing address
3401 MONTANA AVE, EL PASO, TX 79903-4330
(915) 564-5923
(915) 565-1310
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010688201
—
TX
Enumeration date
09/20/2006
Last updated
04/23/2013
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