Healthcare Provider Details

I. General information

NPI: 1154643948
Provider Name (Legal Business Name): MIRAMAR NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CORPORATE PARK DR STE 123
HENDERSON NV
89074-8771
US

IV. Provider business mailing address

118 CORPORATE PARK DR STE 123
HENDERSON NV
89074-8771
US

V. Phone/Fax

Practice location:
  • Phone: 702-478-5353
  • Fax: 702-478-5959
Mailing address:
  • Phone: 702-478-5353
  • Fax: 702-478-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: TODD HOWELL
Title or Position: CFO
Credential:
Phone: 702-400-4500