Provider Demographics
NPI:1841741584
Name:PROHEALTH BRACES
Entity Type:Organization
Organization Name:PROHEALTH BRACES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-496-3107
Mailing Address - Street 1:1172 S HIGHWAY 118 STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-3116
Mailing Address - Country:US
Mailing Address - Phone:435-287-4444
Mailing Address - Fax:
Practice Address - Street 1:1172 S HIGHWAY 118 STE 101
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-3116
Practice Address - Country:US
Practice Address - Phone:435-287-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies