Healthcare Provider Details

I. General information

NPI: 1801304233
Provider Name (Legal Business Name): CHARLES F THOMASSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E TROPICANA AVE STE 175A
LAS VEGAS NV
89119-6507
US

IV. Provider business mailing address

1455 E TROPICANA AVE STE 175A
LAS VEGAS NV
89119-6507
US

V. Phone/Fax

Practice location:
  • Phone: 702-893-2001
  • Fax: 702-364-3334
Mailing address:
  • Phone: 702-893-2002
  • Fax: 702-364-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: