Provider Demographics
NPI:1043966443
Name:RONDA'S MEDICAL WIGS, LLC
Entity type:Organization
Organization Name:RONDA'S MEDICAL WIGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LA RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:PROSTHETIC/ORTHOTIC
Authorized Official - Phone:310-370-7757
Mailing Address - Street 1:16815 STE B PRARIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3009
Mailing Address - Country:US
Mailing Address - Phone:310-370-7757
Mailing Address - Fax:
Practice Address - Street 1:16815 PRAIRIE AVE STE B
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3009
Practice Address - Country:US
Practice Address - Phone:424-215-2105
Practice Address - Fax:424-675-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies