Individual
DR. JACQUELINE RANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
874 AMERICAN PACIFIC DR, HENDERSON, NV 89014-8800
(702) 777-3122
(702) 777-3055
Mailing address
874 AMERICAN PACIFIC DR, HENDERSON, NV 89014-8800
(702) 777-3122
(702) 777-3055
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2845
NV
2251X0800X
Orthopedic Physical Therapist
PT28176
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54220ZZZ07464Z
BLUE SHIELD PIN
CA
01
—
P00066377
RAILROAD MEDICARE
CA
Enumeration date
05/31/2005
Last updated
07/23/2013
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