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General NPI Number Information
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NPI Number | 1275838799
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Entity Type | Organization
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Legal Business Name | MBD LLC DBA MIRACLE EAR
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 1245 W. WARM SPRINGS RD (INSIDE SEARS MIRACLE EAR HEARING
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City | HENDERSON
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State | NV
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Zip | 89014
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Country | US
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Telephone | 702-451-5363
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Fax | 702-451-5515
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Provider Business Mailing Address
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Address Line | P.O. BOX 778238
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City | HENDERSON
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State | NV
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Zip | 89077
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Country | US
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Telephone | 702-451-5363
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Fax | 702-451-5515
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA MAESTAS
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Credential |
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Telephone | 702-451-5363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | NV256
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | #256
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License Number State | NV
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