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NPI Code Detail

MEDICARE: CAROLYN D VICTORIAN PCA

MEDICARE: CAROLYN D VICTORIAN PCA
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1821799107
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN D VICTORIAN PCA
Provider Business Mailing Address
First Line : 3920 W CHARLESTON BLVD STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1651
Country : US
Telephone Number : 702-822-0447
Fax Number : 702-915-7664
Provider Business Practice Location Address
First Line : 3920 W CHARLESTON BLVD STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1651
Country : US
Telephone Number : 170-282-2044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2023
Last Update Date : 03/14/2023

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