Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1043567142 |
---|---|
Provider Name | Samantha Chloe Fernandez |
First Address | Las Vegas, NV 89183-5665 |
Second Address | Las Vegas, NV 89118-5852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2012 |
Last Update Date | 07/08/2012 |