Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 1103 | NV |
N | 207X00000X | Orthopaedic Surgeon | 20A8358 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1103 | NV |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 20A8358 | CA |
NPI | 1205883642 |
---|---|
Provider Name | Dr. Randa Amin Bascharon |
First Address | Las Vegas, NV 89103 |
Second Address | Las Vegas, NV 89117-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 24/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100503044 | (05) | NV |
H87776 | (02) | NV |
XTE006922 | CALIF MEDI-CAL (01) | CA |