Healthcare Provider Details

I. General information

NPI: 1063759421
Provider Name (Legal Business Name): DAVID A KOVACH CP, BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WHITNEY RANCH DR STE C17
HENDERSON NV
89014-2657
US

IV. Provider business mailing address

600 WHITNEY RANCH DR E-28
HENDERSON NV
89014-2611
US

V. Phone/Fax

Practice location:
  • Phone: 702-898-6000
  • Fax: 702-898-6080
Mailing address:
  • Phone: 702-898-6000
  • Fax: 702-898-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO 3298
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: