Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHEA CLARK (OWNER)
(702) 850-2898
Entity
Organization
Contact information
Practice address
2820 W CHARLESTON BLVD STE 32, LAS VEGAS, NV 89102-1934
(702) 850-2898
(702) 850-2836
Mailing address
2820 W CHARLESTON BLVD STE 32, LAS VEGAS, NV 89102-1934
(702) 850-2898
(702) 850-2836
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
NV20151659970
NV
Other
Enumeration date
12/31/2015
Last updated
12/23/2016
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