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General NPI Number Information
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NPI Number | 1144518440
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Entity Type | Individual
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Provider Name | CHARLI MACKABEE
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Gender | Female
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 3170 E SUNSET RD A
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City | LAS VEGAS
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State | NV
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Zip | 89120-2745
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Country | US
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Telephone | 702-629-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 15095 AMARGOSA RD STE 208
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City | VICTORVILLE
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State | CA
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Zip | 92394-1879
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Country | US
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Telephone | 760-245-4695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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