Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 63ADZ-18 | NV |
NPI | 1548714520 |
---|---|
Provider Name | Prudence Landicho |
First Address | Las Vegas, NV 89117-7646 |
Second Address | Las Vegas, NV 89121-6318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 08/08/2016 |