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General NPI Number Information
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NPI Number | 1871897603
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Entity Type | Organization
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Legal Business Name | ESCENTUALS MEDICAL SUPPLY
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 5025 S EASTERN AVE STE 4
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City | LAS VEGAS
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State | NV
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Zip | 89119-2309
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Country | US
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Telephone | 702-245-1966
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Fax | 702-947-2248
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Provider Business Mailing Address
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Address Line | 5025 S EASTERN AVE STE 4
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City | LAS VEGAS
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State | NV
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Zip | 89119-2309
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Country | US
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Telephone | 702-245-1966
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Fax | 702-947-2248
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Authorized Official
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Title or Position | DIRECTOR/MANAGER OF OPERATIONS
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Name | MRS. BOLA N LEE
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Credential | LPN
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Telephone | 702-245-1966
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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 |
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License Number State |
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