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General NPI Number Information
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NPI Number | 1639660657
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Entity Type | Individual
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Provider Name | KAUMADA RANGANISRI DALUGODA CADC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 2290 MCDANIEL ST # 1C
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City | N LAS VEGAS
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State | NV
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Zip | 89030-6329
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Country | US
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Telephone | 702-399-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 975 SEVEN HILLS DR APT 1521
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City | HENDERSON
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State | NV
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Zip | 89052-4319
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Country | US
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Telephone | 702-797-0835
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 00757-C
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License Number State | NV
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