1497315949 NPI number — DEBRA DENISE RAMBO PERSONAL CARE ASSIST

Table of content: DEBRA DENISE RAMBO PERSONAL CARE ASSIST (NPI 1497315949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497315949 NPI number — DEBRA DENISE RAMBO PERSONAL CARE ASSIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMBO
Provider First Name:
DEBRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PERSONAL CARE ASSIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497315949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8846 FORT CRESTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89129-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-969-9343
Provider Business Mailing Address Fax Number:
702-776-3102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8846 FORT CRESTWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89129-3636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-969-9343
Provider Business Practice Location Address Fax Number:
702-776-3102
Provider Enumeration Date:
06/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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