# CUSTOM REHAB BRACING AND MEDICAL SUPPLY,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932424405
- **Authorized official:** MR. ARCADIO RODRIGUEZ RODRIGUEZ O.T (OWNER)
- **Authorized official phone:** (408) 660-0120

## Contact information

- **Practice address:** 721 RIVER PARK DR, SAN JOSE, CA 95111-1552
- **Practice address phone:** (408) 660-0120
- **Practice address fax:** (408) 333-9632
- **Mailing address:** 721 RIVER PARK DR, SAN JOSE, CA 95111-1552
- **Mailing address phone:** (408) 660-0120
- **Mailing address fax:** (408) 333-9632

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 101-555617 | CA | Yes |

## Other

- **Enumeration date:** 03/29/2010
- **Last updated:** 03/29/2010