Healthcare Provider Details

I. General information

NPI: 1255620035
Provider Name (Legal Business Name): BETSY OMANDAC RT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 BURNHAM AVE STE 255
LAS VEGAS NV
89119-8204
US

IV. Provider business mailing address

4275 BURNHAM AVE STE 255
LAS VEGAS NV
89119-8204
US

V. Phone/Fax

Practice location:
  • Phone: 702-893-3333
  • Fax: 702-893-0960
Mailing address:
  • Phone: 702-893-3333
  • Fax: 702-893-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRC1645
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: