Individual
XAVIERRE PAKINGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1404 SUN COPPER DR, LAS VEGAS, NV 89117-7020
(213) 793-3175
Mailing address
1404 SUN COPPER DR, LAS VEGAS, NV 89117-7020
(213) 793-3175
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291386
—
GU
Enumeration date
07/22/2021
Last updated
07/22/2021
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