MEDICARE: BRACE IT O&P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	224900000X	Mastectomy Fitter
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	332BC3200X	Customized Equipment (DME)
4	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1184124885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRACE IT O&P

Provider Business Mailing Address
First Line	:	3170 W SAHARA AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6004
Country	:	US
Telephone Number	:	702-478-5848
Fax Number	:	702-478-5565

Provider Business Practice Location Address
First Line	:	3170 W SAHARA AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6004
Country	:	US
Telephone Number	:	702-478-5848
Fax Number	:	702-478-5565

Authorized Official
Title or Position	:	ORTHOTIST
Name	:	MR. YAHVE GONZALEZ
Credential	:	BOCO
Telephone Number	:	702-478-5848

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	09/15/2022

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Directions to “BRACE IT O&P ” Practice Location

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