Healthcare Provider Details

I. General information

NPI: 1497028682
Provider Name (Legal Business Name): DEJA RACHELLE ETHEL FUIMAONO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEJA RACHELLE ETHEL EDWARDS

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 03/06/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W CHEYENNE AVE STE 190
NORTH LAS VEGAS NV
89030-3983
US

IV. Provider business mailing address

8321 BELLO CIRCONDA AVE
LAS VEGAS NV
89178-8257
US

V. Phone/Fax

Practice location:
  • Phone: 702-350-1898
  • Fax:
Mailing address:
  • Phone: 702-350-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8661-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: