Provider Demographics
NPI:1538563788
Name:EDWARD E SIXTA
Entity type:Organization
Organization Name:EDWARD E SIXTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIXTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-284-8890
Mailing Address - Street 1:1544 PITTMAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5618
Mailing Address - Country:US
Mailing Address - Phone:775-284-8890
Mailing Address - Fax:775-284-8893
Practice Address - Street 1:1544 PITTMAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5618
Practice Address - Country:US
Practice Address - Phone:775-284-8890
Practice Address - Fax:775-284-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20091243861332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies