MEDICARE: DESERT ROSE MEDICAL SUPPLIES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	H13-00304-1-131902	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548343395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT ROSE MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	3400 SIRIUS AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8310
Country	:	US
Telephone Number	:	702-889-8414
Fax Number	:	702-889-2161

Provider Business Practice Location Address
First Line	:	3400 SIRIUS AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8310
Country	:	US
Telephone Number	:	702-889-8414
Fax Number	:	702-889-2161

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. OLIVER FLORENTINO
Credential	:
Telephone Number	:	702-889-8414

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	02/28/2012

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