Provider Demographics
NPI:1407444318
Name:BRACE YOUR SELF MD LLC
Entity Type:Organization
Organization Name:BRACE YOUR SELF MD LLC
Other - Org Name:C/O CHRIS CRUZ, SOLE MEMBER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER/SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-904-4780
Mailing Address - Street 1:2821 E COMMERCIAL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4216
Mailing Address - Country:US
Mailing Address - Phone:954-904-4780
Mailing Address - Fax:954-990-7056
Practice Address - Street 1:2821 E COMMERCIAL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4216
Practice Address - Country:US
Practice Address - Phone:954-904-4780
Practice Address - Fax:954-990-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies