MEDICARE: CHRISTIAN KALANI MATEO BAAY LAT, ATC

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	2255A2300X	Athletic Trainer	0506746	NV

General Provider Information

NPI Number	:	1538856653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN KALANI MATEO BAAY LAT, ATC

Provider Business Mailing Address
First Line	:	1808 LUNA VISTA PL
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 LUNA VISTA PL
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2084
Country	:	US
Telephone Number	:	702-289-9753
Fax Number	:

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	10/16/2023

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