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NPI Code Detail

MEDICARE: KARINA ISELA BRACAMONTE

MEDICARE: KARINA ISELA BRACAMONTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1417383787
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARINA ISELA BRACAMONTE
Provider Business Mailing Address
First Line : 3921 HAMPTON GROVE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7922
Country : US
Telephone Number : 702-498-3865
Fax Number :
Provider Business Practice Location Address
First Line : 4424 LOMA CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-5204
Country : US
Telephone Number : 702-373-1651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2013
Last Update Date : 09/18/2013

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Directions to “ KARINA ISELA BRACAMONTE ” Practice Location

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