Provider Demographics
NPI:1548343395
Name:DESERT ROSE MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:DESERT ROSE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-889-8414
Mailing Address - Street 1:3400 SIRIUS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8310
Mailing Address - Country:US
Mailing Address - Phone:702-889-8414
Mailing Address - Fax:702-889-2161
Practice Address - Street 1:3400 SIRIUS AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8310
Practice Address - Country:US
Practice Address - Phone:702-889-8414
Practice Address - Fax:702-889-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH13-00304-1-131902332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302261Medicaid
NV5865310001Medicare NSC