MEDICARE: DESIREE CASTONGUAY PA-C

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	363A00000X	Physician Assistant	085005377	IL
2	363A00000X	Physician Assistant	2023006254	MO
3	363AS0400X	Surgical Physician Assistant	085005377	IL
4	363A00000X	Physician Assistant	PA2685	NV

General Provider Information

NPI Number	:	1730578535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE CASTONGUAY PA-C

Provider Business Mailing Address
First Line	:	3016 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1973
Country	:	US
Telephone Number	:	702-780-2315
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 S RAINBOW BLVD STE 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1807
Country	:	US
Telephone Number	:	26-716-4807
Fax Number	:

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

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	06/15/2023

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Directions to “ DESIREE CASTONGUAY PA-C” Practice Location

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