| NPI | 1255099743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIZEL TRINIDAD JACOBSEN Administrator 702-601-8456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2022-07-28 |