Healthcare Provider Details

I. General information

NPI: 1790373108
Provider Name (Legal Business Name): CHARDAE HURESKIN COSMETOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W SUNSET RD
HENDERSON NV
89014-6848
US

IV. Provider business mailing address

8905 GOLDSTONE AVE
LAS VEGAS NV
89143-1396
US

V. Phone/Fax

Practice location:
  • Phone: 702-767-6164
  • Fax:
Mailing address:
  • Phone: 702-767-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: