Provider Demographics
NPI:1659370294
Name:SPORTS BRACING USA, INC.
Entity Type:Organization
Organization Name:SPORTS BRACING USA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-978-1114
Mailing Address - Street 1:3162 NEWBERRY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1500
Mailing Address - Country:US
Mailing Address - Phone:408-978-1114
Mailing Address - Fax:408-978-1166
Practice Address - Street 1:3162 NEWBERRY DR
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1500
Practice Address - Country:US
Practice Address - Phone:408-978-1114
Practice Address - Fax:408-978-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1135070001Medicare ID - Type Unspecified