Healthcare Provider Details

I. General information

NPI: 1467290072
Provider Name (Legal Business Name): RACHELLE PANGILINAN MANALO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PILOT RD
LAS VEGAS NV
89119-3542
US

IV. Provider business mailing address

250 PILOT RD
LAS VEGAS NV
89119-3542
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number876778
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number876778
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: