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General NPI Number Information
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NPI Number | 1548343395
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Entity Type | Organization
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Legal Business Name | DESERT ROSE MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 3400 SIRIUS AVE STE A
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City | LAS VEGAS
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State | NV
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Zip | 89102-8310
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Country | US
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Telephone | 702-889-8414
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Fax | 702-889-2161
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Provider Business Mailing Address
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Address Line | 3400 SIRIUS AVE STE A
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City | LAS VEGAS
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State | NV
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Zip | 89102-8310
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Country | US
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Telephone | 702-889-8414
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Fax | 702-889-2161
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Authorized Official
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Title or Position | MANAGER
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Name | MR. OLIVER FLORENTINO
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Credential |
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Telephone | 702-889-8414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | H13-00304-1-131902
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License Number State | NV
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