Healthcare Provider Details

I. General information

NPI: 1811109465
Provider Name (Legal Business Name): MICHELE ANNE QUINONES PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. MICHELE RAYMUNDO

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 CLIFF SHADOWS PKWY STE 250
LAS VEGAS NV
89129-5112
US

IV. Provider business mailing address

PO BOX 36310
LAS VEGAS NV
89133-6310
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-1599
  • Fax: 702-240-4962
Mailing address:
  • Phone: 702-382-1599
  • Fax: 702-240-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2855
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: