Provider Demographics
NPI:1053078063
Name:PALABASAN, EMILIE
Entity Type:Individual
Prefix:MISS
First Name:EMILIE
Middle Name:
Last Name:PALABASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 S NELLIS BLVD APT 1106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7703
Mailing Address - Country:US
Mailing Address - Phone:225-371-1230
Mailing Address - Fax:
Practice Address - Street 1:5410 LINDERO PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2713
Practice Address - Country:US
Practice Address - Phone:702-490-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20211999944261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service