Provider Demographics
NPI:1093960619
Name:DORIS W MENG BRA BOUTIQUE
Entity Type:Organization
Organization Name:DORIS W MENG BRA BOUTIQUE
Other - Org Name:DBA BRA BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:MENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-362-1579
Mailing Address - Street 1:2375 S JONES BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3169
Mailing Address - Country:US
Mailing Address - Phone:702-362-1579
Mailing Address - Fax:702-368-4609
Practice Address - Street 1:2375 S JONES BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3169
Practice Address - Country:US
Practice Address - Phone:702-362-1579
Practice Address - Fax:702-368-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC07011400034776332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0452980001Medicare NSC