Healthcare Provider Details

I. General information

NPI: 1205883642
Provider Name (Legal Business Name): RANDA AMIN BASCHARON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7281 W SAHARA AVE STE 110
LAS VEGAS NV
89117-2802
US

IV. Provider business mailing address

4132 S RAINBOW #393
LAS VEGAS NV
89103
US

V. Phone/Fax

Practice location:
  • Phone: 702-947-7790
  • Fax: 702-947-7792
Mailing address:
  • Phone: 702-947-7790
  • Fax: 702-947-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1103
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A8358
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number1103
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number20A8358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: