Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1730610890 |
---|---|
Provider Name | Cassandra Virgil |
First Address | Las Vegas, NV 89103-2799 |
Second Address | Las Vegas, NV 89103-2799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 21/03/2017 |