MEDICARE: RANDA BASCHARON,D.O. INC

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
1	207X00000X	Orthopaedic Surgery Physician	2OA8358	CA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	1103	NV
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	2OA8358	CA
4	207X00000X	Orthopaedic Surgery Physician	1103	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XTE006922	OTHER		CALIF MEDI-CAL ID

General Provider Information

NPI Number	:	1114961539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDA BASCHARON,D.O. INC

Provider Business Mailing Address
First Line	:	4132 S RAINBOW BLVD
Second Line	:	#393
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3106
Country	:	US
Telephone Number	:	702-596-0036
Fax Number	:	702-947-7792

Provider Business Practice Location Address
First Line	:	7281 W SAHARA AVE
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2816
Country	:	US
Telephone Number	:	702-947-7790
Fax Number	:	702-947-7792

Authorized Official
Title or Position	:	PRES, SEC,
Name	:	RANDA AMIN BASCHARON
Credential	:	DO
Telephone Number	:	702-596-0036

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	09/03/2010

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