Organization
PROFORMA MEDICAL SOURC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE VILLANUEVA (VICE PRESIDENT)
(800) 875-8455
Entity
Organization
Contact information
Practice address
800 N RAINBOW BLVD, STE 215, LAS VEGAS, NV 89107-1189
(800) 875-8455
(702) 948-7616
Mailing address
800 N RAINBOW BLVD, STE 215, LAS VEGAS, NV 89107-1189
(800) 875-8455
(702) 948-7616
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/17/2006
Last updated
08/01/2008
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