Provider Demographics
NPI:1447389291
Name:NOSE BRACE, INC.
Entity type:Organization
Organization Name:NOSE BRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAKHANY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-249-4047
Mailing Address - Street 1:650 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2524
Mailing Address - Country:US
Mailing Address - Phone:408-249-4047
Mailing Address - Fax:408-249-4734
Practice Address - Street 1:650 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2524
Practice Address - Country:US
Practice Address - Phone:408-249-4047
Practice Address - Fax:408-249-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA1447389291335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies