Provider Demographics
NPI:1184124885
Name:BRACE IT O&P
Entity type:Organization
Organization Name:BRACE IT O&P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YAHVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:702-478-5848
Mailing Address - Street 1:3170 W SAHARA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6004
Mailing Address - Country:US
Mailing Address - Phone:702-478-5848
Mailing Address - Fax:702-478-5565
Practice Address - Street 1:3170 W SAHARA AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6004
Practice Address - Country:US
Practice Address - Phone:702-478-5848
Practice Address - Fax:702-478-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment