MEDICARE: KAIULANI PRADO

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1403405830	OTHER	NV	DL

General Provider Information

NPI Number	:	1306496575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIULANI PRADO

Provider Business Mailing Address
First Line	:	1500 E TROPICANA AVE STE 158
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6516
Country	:	US
Telephone Number	:	702-450-1704
Fax Number	:	702-650-0201

Provider Business Practice Location Address
First Line	:	1500 E TROPICANA AVE STE 158
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6516
Country	:	US
Telephone Number	:	702-450-1704
Fax Number	:	702-650-0201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	12/04/2020

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Directions to “ KAIULANI PRADO ” Practice Location

Language	Start Address	Practice Location

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