Provider Demographics
NPI:1760267561
Name:ECLIPSE DURABLE SUPPLIES LLC
Entity Type:Organization
Organization Name:ECLIPSE DURABLE SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISADORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OTANO GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-912-9886
Mailing Address - Street 1:2121 E FLAMINGO RD STE 114
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5123
Mailing Address - Country:US
Mailing Address - Phone:702-912-9886
Mailing Address - Fax:
Practice Address - Street 1:1650 E SAHARA AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3495
Practice Address - Country:US
Practice Address - Phone:702-573-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies