MEDICARE: ABIGAIL ROSE CAMACHO-HATTAL

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	163W00000X	Registered Nurse	883039	NV

General Provider Information

NPI Number	:	1316563620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ROSE CAMACHO-HATTAL

Provider Business Mailing Address
First Line	:	9811 W CHARLESTON BLVD # 2-641
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:	855-864-4322
Fax Number	:	866-854-2867

Provider Business Practice Location Address
First Line	:	2950 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5209
Country	:	US
Telephone Number	:	725-251-3854
Fax Number	:

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	10/18/2024

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