Healthcare Provider Details

I. General information

NPI: 1730712035
Provider Name (Legal Business Name): JACLYN ARDUINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 02/15/2020
Certification Date: 02/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 EDMOND ST STE 300
LAS VEGAS NV
89118-3502
US

IV. Provider business mailing address

3569 SCOTT ROAD
KELOWNA BRITISH COLUMBIA
V1W3H5
CA

V. Phone/Fax

Practice location:
  • Phone: 702-330-6152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0506421
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: