Provider Demographics
NPI:1871061895
Name:SILHOUETTEPOST SURGICAL & CUSTOM LINGERIE LLC
Entity type:Organization
Organization Name:SILHOUETTEPOST SURGICAL & CUSTOM LINGERIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BENTA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FRIES ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:559-326-8491
Mailing Address - Street 1:10490 E CEDARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-4637
Mailing Address - Country:US
Mailing Address - Phone:559-326-8491
Mailing Address - Fax:559-765-4405
Practice Address - Street 1:7055 N MAPLE AVE STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8012
Practice Address - Country:US
Practice Address - Phone:559-326-8491
Practice Address - Fax:559-765-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies