Individual
PA DER CHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3850 LAS VEGAS BLVD S, LAS VEGAS, NV 89109-4324
(952) 222-2222
Mailing address
3850 LAS VEGAS BLVD S, LAS VEGAS, NV 89109-4324
(952) 222-2222
Taxonomy
Speciality
Code
Description
License number
State
213EP0504X
Public Medicine Podiatrist
Primary
123456
NV
Other
Enumeration date
02/27/2015
Last updated
08/10/2015
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