Healthcare Provider Details

I. General information

NPI: 1417458399
Provider Name (Legal Business Name): CHRISTIAN BEJARANO PADILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 S JONES BLVD STE 105B
LAS VEGAS NV
89146-5628
US

IV. Provider business mailing address

2780 S JONES BLVD STE 105B
LAS VEGAS NV
89146-5628
US

V. Phone/Fax

Practice location:
  • Phone: 702-333-1488
  • Fax: 702-933-9547
Mailing address:
  • Phone: 702-333-1488
  • Fax: 702-933-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: