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NPI Code Detail

MEDICARE: LA FONDA RENEE DEE

MEDICARE:   LA FONDA RENEE DEE
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1790092146
Entity Type Code : Individual
Provider Name (Legal Business Name) : LA FONDA RENEE DEE
Provider Business Mailing Address
First Line : 2126 SLEEPY CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3676
Country : US
Telephone Number : 702-510-2902
Fax Number :
Provider Business Practice Location Address
First Line : 2126 SLEEPY CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3676
Country : US
Telephone Number : 702-510-2902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2010
Last Update Date : 02/21/2012

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Directions to “ LA FONDA RENEE DEE ” Practice Location

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