MEDICARE: MR. SAUL JOSHUA RANDALL MS CPCI NCC

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	225400000X	Rehabilitation Practitioner
2	101YP2500X	Professional Counselor	CI0181	NV

General Provider Information

NPI Number	:	1518230952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAUL JOSHUA RANDALL MS CPCI NCC

Provider Business Mailing Address
First Line	:	7837 SILVER PLATEAU AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2657
Country	:	US
Telephone Number	:	702-672-1243
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 W CHARLESTON BLVD
Second Line	:	SUITE #70
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1941
Country	:	US
Telephone Number	:	702-823-3910
Fax Number	:

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

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	08/25/2016

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