1699501924 NPI number — HIP HOP GLAMM

Table of content: DR. ELIZABETH JEAN BRUCE PH.D. (NPI 1447456900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699501924 NPI number — HIP HOP GLAMM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIP HOP GLAMM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699501924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10440 N CENTRAL EXPY STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-2264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-888-4401
Provider Business Mailing Address Fax Number:
469-574-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3560 W CAMP WISDOM RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-888-4401
Provider Business Practice Location Address Fax Number:
469-574-5550
Provider Enumeration Date:
09/12/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KINGCANNON
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
214-888-4401

Provider Taxonomy Codes

  • Taxonomy code: 101200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 102X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)