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	20A8358	CA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	1103	NV
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	20A8358	CA
4	207X00000X	Orthopaedic Surgery Physician	1103	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1174564009
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	:	6850 N DURANGO DR
Second Line	:	#218
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4595
Country	:	US
Telephone Number	:	702-947-7790
Fax Number	:	702-947-7792

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	02/18/2010

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Directions to “RANDA BASCHARON D.O., INC ” Practice Location

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