Healthcare Provider Details

I. General information

NPI: 1962104398
Provider Name (Legal Business Name): OLGA BRAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 W TROPICANA AVE
LAS VEGAS NV
89103-5060
US

IV. Provider business mailing address

4850 W FLAMINGO RD STE 25AB
LAS VEGAS NV
89103-3705
US

V. Phone/Fax

Practice location:
  • Phone: 725-259-5662
  • Fax:
Mailing address:
  • Phone: 702-871-9917
  • Fax: 702-852-0887

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: