Provider Demographics
NPI:1073927810
Name:HAMBLIN, CHARDAI
Entity Type:Individual
Prefix:
First Name:CHARDAI
Middle Name:
Last Name:HAMBLIN
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 1:2251 S FORT APACHE RD
Mailing Address - Street 2:APT. 2160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5758
Mailing Address - Country:US
Mailing Address - Phone:702-589-1900
Mailing Address - Fax:
Practice Address - Street 1:2251 S FORT APACHE RD
Practice Address - Street 2:APT. 2160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5758
Practice Address - Country:US
Practice Address - Phone:702-589-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner