Individual
FANTASI PRIDGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1555 E FLAMINGO RD STE 158, LAS VEGAS, NV 89119-9305
(702) 385-9097
Mailing address
820 MIDPRIDE ST, LAS VEGAS, NV 89144-1345
(702) 513-3447
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/22/2013
Last updated
04/22/2013
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