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NPI Code Detail

MEDICARE: DR. JACQUELINE RANDA PT

MEDICARE: DR. JACQUELINE RANDA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical TherapistPT28176CA
22251X0800XOrthopedic Physical Therapist2845NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00066377OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
154220ZZZ07464ZOTHERCABLUE SHIELD PIN

General Provider Information

NPI Number : 1013919349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE RANDA PT
Provider Business Mailing Address
First Line : 874 AMERICAN PACIFIC DR
Second Line :
City : HENDERSON
State : NV
Zip : 89014-8800
Country : US
Telephone Number : 702-777-3122
Fax Number : 702-777-3055
Provider Business Practice Location Address
First Line : 874 AMERICAN PACIFIC DR
Second Line :
City : HENDERSON
State : NV
Zip : 89014-8800
Country : US
Telephone Number : 702-777-3122
Fax Number : 702-777-3055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 07/23/2013

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Directions to “ DR. JACQUELINE RANDA PT” Practice Location

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