Provider Demographics
NPI:1306892336
Name:RENO ORTHOPEDIC APPLIANCE
Entity type:Organization
Organization Name:RENO ORTHOPEDIC APPLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:775-322-9299
Mailing Address - Street 1:314 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2910
Mailing Address - Country:US
Mailing Address - Phone:775-322-9299
Mailing Address - Fax:775-322-1672
Practice Address - Street 1:314 VASSAR ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2910
Practice Address - Country:US
Practice Address - Phone:775-322-9299
Practice Address - Fax:775-322-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV335E00000X335E00000X
NV332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0198580001Medicare NSC