Healthcare Provider Details

I. General information

NPI: 1093056624
Provider Name (Legal Business Name): ODAIMY CASUSO AGUILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 E DESERT INN RD STE 200
LAS VEGAS NV
89169-2548
US

IV. Provider business mailing address

1580 E DESERT INN RD SUITE 200
LAS VEGAS NV
89169-2548
US

V. Phone/Fax

Practice location:
  • Phone: 702-836-3442
  • Fax: 702-836-9367
Mailing address:
  • Phone: 702-457-7542
  • Fax: 702-450-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: