MEDICARE: BLESELDA G PARAGAS PA-C

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
1	363AM0700X	Medical Physician Assistant	PA702	NV

General Provider Information

NPI Number	:	1437348265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLESELDA G PARAGAS PA-C

Provider Business Mailing Address
First Line	:	229 N PECOS RD STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7364
Country	:	US
Telephone Number	:	702-367-6370
Fax Number	:	702-433-4238

Provider Business Practice Location Address
First Line	:	2800 N TENAYA WAY STE 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1100
Country	:	US
Telephone Number	:	702-367-6370
Fax Number	:	702-307-5480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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