MEDICARE: PRUDENCE LANDICHO

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	175L00000X	Homeopath	63ADZ-18	NV

General Provider Information

NPI Number	:	1548714520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRUDENCE LANDICHO

Provider Business Mailing Address
First Line	:	7985 MERLEWOOD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7646
Country	:	US
Telephone Number	:	702-526-7677
Fax Number	:	702-586-0643

Provider Business Practice Location Address
First Line	:	4062 MONTHILL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6318
Country	:	US
Telephone Number	:	702-451-3284
Fax Number	:	702-451-3284

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

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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Directions to “ PRUDENCE LANDICHO ” Practice Location

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