Provider Demographics
NPI:1780305292
Name:JTBUNDLES SALON AND BARBER
Entity type:Organization
Organization Name:JTBUNDLES SALON AND BARBER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPLIER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIALIST
Authorized Official - Phone:562-416-1656
Mailing Address - Street 1:15620 S NORMANDIE AVE APT J
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4041
Mailing Address - Country:US
Mailing Address - Phone:562-416-1656
Mailing Address - Fax:
Practice Address - Street 1:61 LAKEWOOD CENTER MALL STE J
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2417
Practice Address - Country:US
Practice Address - Phone:562-416-1656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies