Healthcare Provider Details

I. General information

NPI: 1891116026
Provider Name (Legal Business Name): HUTANO TECHNOLOGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7470 DEAN MARTIN DR STE 102
LAS VEGAS NV
89139-5944
US

IV. Provider business mailing address

10118 TANNER RAPIDS CT
LAS VEGAS NV
89148-1626
US

V. Phone/Fax

Practice location:
  • Phone: 702-707-3464
  • Fax:
Mailing address:
  • Phone: 702-530-1557
  • Fax: 702-989-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2642
License Number StateNV

VIII. Authorized Official

Name: DR. EPHRAIM MAKUVE
Title or Position: CEO
Credential: PT, DPT
Phone: 702-758-9671