Organization
RANDA BASCHARON D.O., INC
Active
Other names
ORTHOPEDIC & SPORTS MEDICINE INSTITUTE OF LAS VEGAS
Organization subpart
No
Provider details
NPI number
Authorized official
RANDA AMIN BASCHARON DO (OWNER PRES SEC ETC)
(702) 596-0036
Entity
Organization
Contact information
Practice address
6850 N DURANGO DR, #218, LAS VEGAS, NV 89149-4595
(702) 947-7790
(702) 947-7792
Mailing address
4132 S RAINBOW BLVD, #393, LAS VEGAS, NV 89103-3106
(702) 596-0036
(702) 947-7792
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
1103
NV
207X00000X
Orthopaedic Surgery Physician
20A8358
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
1103
NV
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
20A8358
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100503044
—
NV
01
—
XTE006922
CALIF MEDI-CAL
CA
Enumeration date
06/10/2006
Last updated
02/18/2010
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