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General NPI Number Information
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NPI Number | 1992019616
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Entity Type | Organization
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Legal Business Name | DESERT ORTHOTICS LLC
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 600 WHITNEY RANCH DR SUITE C13
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City | HENDERSON
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State | NV
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Zip | 89014-2611
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Country | US
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Telephone | 702-435-7987
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Fax | 702-435-7616
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Provider Business Mailing Address
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Address Line | 600 WHITNEY RANCH DR SUITE C-13
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City | HENDERSON
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State | NV
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Zip | 89014-2611
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Country | US
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Telephone | 702-435-7987
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Fax | 702-435-7616
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH ERVINE FATKIN
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Credential | DPM
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Telephone | 702-435-7987
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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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