Provider Demographics
NPI:1124675848
Name:NEVADA LIMB & BRACE LLC
Entity type:Organization
Organization Name:NEVADA LIMB & BRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARDEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-899-1700
Mailing Address - Street 1:1505 WIGWAM PKWY SUITE 141
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8195
Mailing Address - Country:US
Mailing Address - Phone:702-899-1700
Mailing Address - Fax:702-899-1813
Practice Address - Street 1:1505 WIGWAM PKWY SUITE 141
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-899-1700
Practice Address - Fax:702-899-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment