MEDICARE: MRS. DEJA RACHELLE ETHEL FUIMAONO MSW, LCSW

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	253J00000X	Foster Care Agency
2	1041C0700X	Clinical Social Worker	8661-C	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497028682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEJA RACHELLE ETHEL FUIMAONO MSW, LCSW

Provider Business Mailing Address
First Line	:	8321 BELLO CIRCONDA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8257
Country	:	US
Telephone Number	:	702-350-1898
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 W CHEYENNE AVE STE 190
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3983
Country	:	US
Telephone Number	:	702-350-1898
Fax Number	:

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

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	03/06/2025

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